Text and list of links - 3 9956

 

Jargon buster - 0 9952

 

Gynaecology

Laparoscopy


IntroductionShow [+]Hide [-]

Laparoscopy is a commonly performed procedure to examine the abdominal or pelvic organs. Investigations, and some keyhole surgery procedures, can be performed with laparoscopy where in the past the abdomen would have to be opened in an operation known as a laparotomy.

Why it might be needed

Laparoscopy is performed to investigate or diagnose a range of conditions. It may be used to

  • investigate the cause of abdominal pain (eg a possible abscess)
  • investigate the cause of gynaecological pain (eg endometriosis)
  • investigate the cause of infertility
  • monitor the effects of infertility drugs on the ovaries

Laparoscopy is also used to provide a view for surgical procedures such as

  • removal of the appendix or gallbladder
  • removal of an ovarian cyst
  • repair of hernia
  • sterilisation in women

Before your procedureShow [+]Hide [-]

Any preparations depend on the reason for the procedure. For planned, rather than urgent, laparoscopy, you may be asked to visit the hospital one to two weeks before surgery, for a pre-admission assessment with a nurse and/or the anaesthetist.

They will ask you questions about your current and past health and any medicines you are taking. You may be given a physical examination to make sure it is safe for you to have an anaesthetic. You may also be asked to give urine and blood samples for routine laboratory testing. These should reveal potential problems that might complicate the surgery if not detected and treated early.

What to expect in hospital

Follow the fasting instructions that you will have been given in your admission confirmation letter. Usually we ask that you don't eat or drink for about six hours before your general anaesthetic. Though occasional sips of water up to two hours beforehand is usually OK. Check with the nurse.

On the day of the surgery you will be given a physical examination. The procedure will be explained to you and you will be asked to sign a consent form to confirm that you understand the procedure, including the risks, and give your permission for it to go ahead.

During your procedureShow [+]Hide [-]

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. Fibre optic 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 on a monitor.

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.

Remember - you will be asleep with the general anaesthetic during this procedure.

A laparoscopy involves two cuts approximately 5-10mm long. The first cut is made just below the navel. A hollow needle is inserted. This is then connected to a supply of carbon dioxide gas, which is pumped 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 a second small 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 minimises 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.
 

After your ProcedureShow [+]Hide [-]

There may be some discomfort in your 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 the hospital staff will give you 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.

If you have been treated as a day case, you should have somebody to stay with you for the first 24 hours afterwards. After a straightforward laparoscopy involving an examination only, you can expect to recover within a few days.

Complete recovery may take longer (up to 12 weeks) 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.

Other informationShow [+]Hide [-]

Deciding to have a laparoscopy

Laparoscopy is a commonly performed and 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.

Side-effects

Side-effects are the unwanted but usually mild and temporary effects of a successful procedure. Examples of side-effects include feeling sick as a result of the general anaesthetic although medicines are available to help avoid this. After a laparoscopy you are likely to feel some pain in the abdomen as well as "referred pain" (caused by the gas used to inflate the abdomen) in the shoulders. This usually disappears after 48 hours.

Complications

Complications are unexpected problems that can occur during or after the operation. Most people are not affected. The main possible complications of any surgery are excessive bleeding, infection, or an unexpected reaction to the anaesthetic.

Specific complications of laparoscopy are uncommon but can include accidental damage to internal organs, which would require a larger incision to repair. There is also a risk of abdominal bruising, which usually settles without treatment.

Occasionally the surgeon may need to "convert" to open prodecure, involving a larger incision in the abdomen called a laparotomy. This is because sometimes it is impossible to carry out the operation properly or safely using the laparoscope and the surgeon needs a larger 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. Ask your surgeon to explain how these risks apply to you.
 

© Copyright Newcastle upon Tyne Hospitals NHS Foundation Trust 2017 Site by TH_NK