Laparoscopy

A laparoscopy is an operation performed under general anaesthetic to help your gynaecologist make a diagnosis by looking into your pelvis/tummy with a telescope. It is a common surgical procedure and may be used to cure or alleviate a number of gynaecological complaints.

A laparoscopy may be done to find the cause of symptoms such as abdominal pain, pelvic pain, or swelling of the abdomen or pelvis. Or, it may be done to treat an already identified problem. Some common conditions which can be seen by laparoscopy include:

• Endometriosis: The endometrium is the lining of the uterus. Endometriosis occurs when the cells are found outside the uterus often on the fallopian tubes, ovaries and other surrounding organs in the body, such as the bladder or bowel
• Ovarian Cyst: An ovarian cyst is a fluid filled sac which develops in an ovary. Most ovarian cysts are non-cancerous and some can cause problems such as pain and irregular bleeding
• Ectopic Pregnancy: An ectopic pregnancy is where the pregnancy occurs outside the uterus usually in the fallopian tube. The tube may need to be removed.
• Pelvic Inflammatory disease: Pelvic inflammatory disease (PID) is an infection of the womb and/or fallopian tubes
• Adhesions: Adhesions are areas of ‘scar tissue’ which form when pelvic or other internal organs stick together which can happen after surgery or inflammation
• Fertility investigations: Dye test to check tubal patency.

There are two different types of laparoscopy:

• Diagnostic Laparoscopy: to find the cause
• Operative Laparoscopy where simple or complex procedures are performed

These may involve the following procedures:

• Bilateral and salpingo-oophorectomy (BSO). This is the removal or one or both or your ovaries and fallopian tubes
• Treatment of endometriosis
• Ovarian cystectomy (removal of an ovarian cyst)
• Treatment of an ectopic pregnancy
• Dye test (to check tubal patency for fertility investigations)
• Sterilisation
• Division of adhesions (scar tissue).

At your pre-op assessment and on your admission day the nurse will go through your hospital stay and explain your operation. Please do let us know about any concerns you have or if there is any information you think we should know about that will make your stay with us more comfortable.

You will need to make arrangements for your family, children or any other commitments that you have prior to coming in to hospital and to cover the length of your recovery. You will see an anaesthetist and the doctor performing the surgery before you go to theatre. It is not unusual to feel anxious; the nursing staff will gladly discuss how you are feeling and talk you through your emotions.

You can have clear fluids two hours prior to your admission.

A laparoscopy may also be referred to as keyhole surgery as itis performed through small incisions made in the abdomen and tummy button. Special surgical instruments are inserted through the incisions, and the operation is carried out with the aid of an internal telescope and camera system. You will have between
two and four small scars on different parts of your abdomen. Each scar will be between 0.5 cm and 1 cm long.

There are risks with any operation but these are small. The main risks associated with a laparoscopy are:

Common risks:

• Postoperative pain including abdominal and shoulder tip pain
• Urinary infection, retention and/or frequency
• Wound infection, bruising and delayed wound healing.

Uncommon risks:

• Damage to blood vessels
• Damage to the bladder
• Damage to the bowel
• Pelvic abscess or infection
• Venous thrombosis and pulmonary embolism (a blood clot in your leg or lung)
• Failure to gain entry to abdominal cavity and to complete procedure
• Hernia at site of entry
• Haemorrhage requiring blood transfusion
• Return to theatre i.e. because of bleeding
• Unexpected laparotomy (abdominal incision)

In order for you to make an informed choice about your surgery please ask one of the doctors or nurses if you have any questions about the operation before signing the consent form.

As you come round from the anaesthetic you may experience episodes of pain and/or nausea. Please let the nursing staff know and they will assess you and take appropriate action. We will use a pain score to assess your pain 0-10; 0 = No Pain, 10 = Very Strong Pain.

Your nurse will also check your blood pressure, pulse, breathing and temperature and monitor the laparoscopic ports and any vaginal bleeding.

You may have a drip attached (intravenous infusion); once you are fully awake you will be able to start drinking and eating. Your drip will then be discontinued. You can expect pain and discomfort in your lower abdomen for the first few days after the operation. You may also experience shoulder tip pain from the gas and water that is used through the telescope which may get trapped under your rib cage, this is common with laparoscopic surgery. You will be given pain killers to alleviate this.

You will have 2-4 small dressings on the cuts in your abdomen. You may experience trapped wind which can cause discomfort, peppermint water and getting up and walking around will help this.