Laparoscopy is a procedure used to view structures within the pelvis and abdomen. It is usually carried out under general anaesthetic. This procedure is used for the diagnosis and the treatment of endometriosis, ovarian cysts and fertility problems.
Following induction of anaesthesia, the abdominal cavity is inflated with gas to allow a good view of the pelvic organs (i.e. uterus or womb, ovaries and fallopian tubes) and a telescope introduced through a small incision in the umbilicus (naval). Further small incisions are made under direct vision to insert further instruments to allow for a more detailed inspection of the pelvis, and if necessary to allow operation on various pelvic structures.
All procedures under anaesthesia carry small but inherent risks and you should understand these before agreeing to undergo the procedure:
- The risk of anaesthesia for elective or planned surgery under modern conditions is very small indeed. You will be carefully monitored throughout the operation by a fully trained Anaesthetist. However, there are risks intrinsic in all anaesthesia and if you wish to discuss them please feel free to do so when you meet your Anaesthetist before the operation.
- The insertion of the first instrument is a “blind” procedure and despite all precautions does, albeit very rarely, result in damage to underlying structures. This can include:
- Inadvertently placing the needle into a blood vessel causing a carbon dioxide embolus (gas in a blood vessel).
- Although damage to major blood vessels has been recorded (0.2 per 1000 cases), more common is minor damage to blood vessels that can usually be dealt with using laparoscopic surgical techniques.
- Damage to the urinary tract (ie bladder) – uncommon during diagnostic procedures, but can occasionally happen, particularly if the bladder is full prior to surgery. Repair can usually be carried out surgically using laparoscopic techniques.
- Bowel damage. This is by far the most common complication although it is still rare (0.4 per 1000 cases) and is often associated with the bowel being stuck to the abdominal wall, possibly as a result of previous surgery or infection.
If recognised and deal with promptly, there are few complications, but difficulties can arise if the damage is not quickly dealt with.
In order to protect you and to make the surgery easier to perform, we advise that some patients undergoing operative laparoscopy have a completely empty bowel. In the unlikely event of bowel damage, there is then much less risk of contamination. It will be necessary for you to follow a special low residue diet two days prior to surgery and take a strong laxative. An explanatory letter will be sent to you when your admission is arranged if this is necessary.
The puncture incisions are usually closed with a stitch, which may dissolve or is removed in 7 days . It is quite usual for the wound itself to become a little reddened and inflamed. Quite often it will weep a little and even discharge some pus. This will all resolve provided the wound is kept clean and dry. The plasters placed over the wounds at operation should be removed after 24 hours and air allowed to get at the skin. Normal bathing (preferably showering) is permissible.
The wound should be dried (if tender a hair dryer is a good way to do this). It should then be left open, unless, if it is comfortable next to clothing or if moist, a dry non-sticking dressing such as gauze should be placed over it.
It is very common to expect some pain after the procedure. Some pain may occur as a result of inflating the abdomen with gas. As the gas absorbs into the blood stream and is exhaled through the lungs the pain will gradually disappear, usually over 24 or 48 hours. Depending on the surgery carried out there may be some interference in bowel function leading to abdominal distension or bloating and colicky discomfort.
Some difficultly may be experienced in passing urine after the operation. This is because it is usual to empty the bladder by passing a catheter during the procedure. If you experience symptoms of cystitis, namely: passing urine frequently with burning discomfort, try drinking copious amounts of fluid to “flush” through the urine. If your symptoms persist, your urine should be tested for infection, and if necessary, the appropriate antibiotics prescribed.
You may expect some vaginal bleeding from time to time for anything up to 2 weeks after your operation. This is usually due to manipulation of the cervix or womb with instruments. If the bleeding becomes excessive you should seek medical help.
In the first post-operative day you should rest in bed and take limited activity. After this you may resume normal activities although you should not undertake any strenuous physical exercise or heavy lifting for two weeks. You should refrain from sexual intercourse for about 10 days after the operation.
If you require more information or would like to talk to someone from Gynaechoice regarding a Laparoscopy, please get in contact.