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| What is
laparoscopy? |
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Laparoscopy is an operation used to look inside your abdomen. A thin instrument called a laparoscope is inserted through a tiny cut under your belly button to help your doctor look, examine and operate (if needed) in your abdomen without making large cuts. |
| Why it might be needed in Gynaecology |
Laparoscopy is performed to investigate or diagnose a range conditions. It may be used to:
- Investigate the cause of gynaecological pain (e.g. endometriosis)
- Investigate the cause of infertility
- Sterilisation in women
- Removal of an ovarian cyst
- Treatment of ectopic pregnancy
- Hysterectomy
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| What's
involved? |
| The procedure uses a laparoscope. This is a long thin instrument with a light source at its tip, to light up the inside of the abdomen or pelvis. Fibreoptic fibres carry images from a lens, also at the tip of the instrument, to a video monitor, which the surgeon and other theatre staff can view in real time. The laparoscope can be moved around within the abdominal or pelvic cavity to give several different views. Investigations using laparoscopy are routinely performed under a general anaesthetic as a day case, without the need for an overnight stay in hospital. Laparoscopic treatment may require one or more nights as an inpatient, depending on the exact procedure. |
| What tests are needed before
laparoscopy? |
| Any preparations depend on the reason for the procedure. For planned, rather than urgent, laparoscopy, you will have a few blood tests, ECG and chest x-ray to make sure it is safe for you to have an anaesthetic. These should reveal potential problems that might complicate the surgery if not detected and treated early. |
| How is laparoscopy
done? |
A laparoscopy involves two cuts approximately
5-10mm long. The first cut is made just below/above or in the navel. A hollow needle is inserted. This is then connected to a supply of carbon dioxide gas, which is pumped through the needle and into the abdomen. This lifts the wall of the abdomen away from the organs inside, making it easier and safer to insert the laparoscope and examine the internal organs.
The laparoscope is inserted through the cut made on the abdomen. The exact position depends on the reason for the procedure. For instance, women having a gynaecological investigation will usually have the incision in the belly button. This minimizes visible scarring. If the surgeon needs to perform treatment or take samples, additional small cuts are made for long, thin instruments that have been specially designed for this type of surgery. At the end of the procedure, the instruments are removed, the carbon dioxide gas is allowed to escape and the cuts are closed with stitches. |
| What happens afterwards |
| There may be some discomfort in the abdomen for a day or two after laparoscopy due to the presence of some remaining carbon dioxide gas. This will gradually be absorbed by the lining of the abdomen. Any other symptoms will depend on whether any keyhole surgery has been carried out and, if so, what sort. Before you go home you will be given advice about caring for the surgical wounds and when you will need to come back for a follow-up appointment or to have stitches removed. Complete recovery may take longer if any surgery has been carried out. It is important to follow the advice of your surgeon about physical activity, rest and returning to work. |
| Is it a risky
procedure? |
| Laparoscopy is a commonly performed and is a generally safe procedure. For most people, the benefits in terms of improved symptoms, or from having a clear diagnosis of a problem, are greater than the disadvantages. However, in order to give informed consent, anyone deciding whether to have this procedure needs to be aware of the possible side-effects and the risk of complications. |
| What are the risks of laparoscopic
surgery? |
| There is a small risk of general
anaesthesia, infection, bleeding, injury to internal organs. These risks are uncommon and you should discuss with your doctor in further details. |
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Occasionally the surgeon may need to
"convert" to open laparotomy, involving a larger incision in the abdomen. This is because sometimes it is impossible to carry out the operation properly or safely using the laparoscope and the surgeon needs a larger field of view and more direct access to the internal organs. If treatment is planned, the consent form will contain a clause to agree to a conventional laparotomy, if this becomes necessary. The exact chance of having to convert to an open laparotomy will depend on the type of surgery. Overall it occurs in
3-5% of operations. The chance of complications depends on the exact type of operation you are having and other factors, such as your general health. |
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| What are the advantages of this
method? |
| In conventional surgery a long incision is made to gain entry into the abdominal cavity and operate. This result in increased post- operative pain, longer stay in hospital, delayed recovery, long and ugly scars, respiratory problems, higher chance of wound infection, higher chance of incisional hernia, delayed feeding after surgery. The incidence of all these is dramatically reduced by laparoscopic surgery. |
| What procedure can be done by laparoscopic
surgery? |
| In gynaecology the common operations done via laparoscopy are
diagnostic
laparoscopy, lap and dye
test, fertility related procedures, laparoscopy and treatment of endomertriosis,
lap
ligation, lap ovarian cystectomy, laparoscopy and salpingectomy in cases of ectopic
pregnancy, laparoscopic hysterectomy etc. |
| Will I need
anaesthesia? |
| Yes, you will require general anaesthesia. |
| How long do I have to stay in
hospital? |
| A healthy person without any other medical ailments and complications can be investigated on an out- patient basis. They can come in on the day of surgery or the previous day. Following a laparoscopic procedure like ligation, diagnostic laparoscopy, lap and dye test they can be discharged on the same day but for more advanced procedures three to four days in hospital would be the norm. |
| How soon can I start eating after
surgery? |
| If the surgery is uneventful, feeding can be started on the same day once the patient has recovered completely from the effects of anaesthesia, provided no procedure has been performed on the bowel. |
| When can I get back to
work? |
| Usually a weeks rest from the day of surgery should suffice. But it would be advisable for the surgeon to advice based on your progress. |
| Do I have to take absolute bed
rest? |
| No. The advantage of this method as has been previously mentioned is that the incisions are very small, thereby reducing pain and danger of hernia. You can become ambulant as early as pain and anaesthetic factors permit. |
| Is it more expensive than open
surgery? |
| The equipment, maintenance and procedure are more expensive but as the hospital stay and the intake of drugs are reduced it is actually the same if not less than open surgery. |
| Where can I get it
done? |
| It has become very common and is being done in almost every reputed hospital with minimal complication rates. |
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