What is Laparoscopy?
Laparoscopy is an operation in which a telescope is inserted through the umbilicus (belly button) to inspect the pelvic organs i.e. uterus (womb), fallopian tubes and ovaries. Diagnostic laparoscopy is used to try and find a cause for symptoms. Laparoscopy may also be therapeutic, when treatment is performed.
Who might benefit from laparoscopy?
Laparoscopy is useful in evaluating pelvic pain, painful periods, painful intercourse and infertility.
How is laparoscopy performed?
- General anaesthetic is administered.
- Your bladder is emptied with a catheter.
- An instrument is introduced through your cervix into your womb so that it can be moved as required to help visualise the pelvic organs.
- A small cut (1cm) is made inside the umbilicus.
- A needle is introduced via the incision into the abdominal cavity, which fills the abdomen with gas (carbon dioxide). This allows the pelvic organs to be seen more clearly.
- The telescope (laparoscope) is inserted.
- Up to three other small incisions may be made to introduce other necessary instruments into the abdominal cavity.
Which other procedures may be performed during laparoscopy?
- Treatment of endometriosis – Endometriosis occurs when tissue which resembles the lining of the womb is found in other places e.g. in the pelvis. It may cause painful periods, the pain often starting before the period. Endometriotic deposits have a typical appearance and they may be removed at laparoscopy using either heat (cautery) or by cutting them out (excision).
- Dye test – this is used for women who are trying to conceive. Blue dye (which is harmless to you) is introduced into the womb from below. The dye should travel up the tubes and spill out of the ends into the pelvic cavity.
- Adhesiolysis – Adhesions may be caused by previous surgery or infections. Bands of fibrous scar tissue ‘stick’ organs together and may cause pain. If adhesions are not too extensive they may be divided e.g. cut. If adhesions are complicated or extensive you may need a larger open operation at a later date.
- Removal / aspiration of ovarian cysts, removal of ovaries and fallopian tubes.
- Ovarian cysts may be removed or aspirated (drained) using laparoscopy. It is sometimes possible to remove ovaries and fallopian tubes.
- Sterilisation – see separate female sterilisation leaflet.
Is it a safe procedure?
Laparoscopy is a relatively safe procedure. However, it does carry some risks. The overall risk of serious complications is 2 out of every 1000 cases. Your risk will be higher if you are obese, have had previous abdominal surgery or have pre-existing medical problems. Possible risks include:
- Infection – Serious infections of the pelvis are very rare. Minor infections of the wound sites or bladder (cystitis) may occur and usually respond to a course of antibiotics that you can obtain from your doctor
- Bruising – this should settle after about a week
- Shoulder tip pain – this is fairly common and results from the gas introduced into the abdomen. The gas may irritate a nerve under the diaphragm, which also supplies the shoulder.
- Minor bleeding and bruising around the incision
- Feeling sick and vomiting
- Risks from anaesthesia
- Injury to bowel/bladder/major blood vessels – this may occur on entry into the abdominal cavity with any of the previously mentioned instruments. If necessary, the operation will be converted to a “laparotomy” (i.e. a larger incision will be made on your abdomen) to repair any damage caused. However 15% of bowel injuries may not be diagnosed at time of laparoscopy.
You may need to have a blood transfusion if a vessel is damaged. Your hospital stay may be prolonged if these complications occur.
- Complications arising from the use of carbon dioxide during the procedure, such as the gas bubbles entering your veins or arteries
- a blood clot developing in a vein, usually in one of the legs (deep vein thrombosis or DVT), which can break off and block the blood flow in one of the blood vessels in the lungs (pulmonary embolism)
- Uterine perforation – this could happen with the instrument used to move the uterus. Most small holes in the uterus heal by themselves but you may need to be monitored overnight.
- hernia at site of entry
- death; three to eight women in every 100,000 undergoing laparoscopy die as a result of complications (very rare)
Other risks include
- Failure to gain entry into the abdominal cavity – this occasionally happens and you may be offered a repeat attempt at laparoscopy or an open operation at a later stage.
- Unable to identify the cause of your symptoms – Sometimes nothing is found on laparoscopy to account for your symptoms.
Are there alternative diagnostic or treatment options?
- Pelvic ultrasound - This may be helpful in diagnosing some causes of pelvic pain e.g. ovarian cyst but often cannot be used to diagnose others (eg. endometriosis).
- Hystero-salpingogram - This is a test to check for blockage of the fallopian tubes and is performed in the x-ray department. Dye (which shows up on x-rays) is injected into the womb and x-rays are taken to see if it has spilled out of the tubes. A laparoscopy and dye has the advantage of checking for endometriosis and is therefore often preferred when a woman has painful periods or intercourse.
- No treatment - Your gynaecologist will take into account your symptoms, an examination and the results of any tests when considering a laparoscopy. As the procedure is not without risks the patient and doctor have to decide together whether the symptoms warrant a laparoscopy.
What type of anaesthetic is used?
Laparoscopy is performed under a general anaesthetic. It is important to follow the advice on your admission letter and that given by the pre-admission assessment nurse. You will be advised when to stop eating and drinking and whether to stop or continue regular medication. Please follow the pre-operative fasting instructions given by the pre-admission nurse specifically for day surgical procedures to aid recovery.
You should refrain from smoking and drinking alcohol for 48 hours prior to your operation. Please follow the pain relief advice leaflet given by your pre-operative assessment nurse. Please read the instructions on the admission form.
When will I go home after the operation?
If you have a laparoscopy as a Day surgery procedure, you will be allowed to go home a few hours after the procedure if there are no complications. You should have emptied your bladder and not been in severe pain or actively bleeding. Patients should not drive for 48 hours after the procedure so private transport home with a companion must be arranged.
When can I go back to work?
People vary in how quickly they recover after surgery. Depending on your job you may be able to return to work 1–3 weeks after the operation, as long as you feel well.
When can I have sexual intercourse?
Once the vaginal bleeding has stopped.
What about the stitches?
Small plasters will be covering your wounds when you wake up. The stitches normally dissolve, but may require removal at yours doctors practice, if still present after 5-7 days. Showers are preferable to baths and dry plasters should cover your wounds for three days, so try not to get them wet. After three days the wounds should be left uncovered and kept clean and dry.
When should I seek urgent medical advice after laparoscopy?
If you experience
- increasing abdominal pain
- high temperature (fever),
- loss of appetite,
- nausea or vomiting, this may be caused by damage to your bowel or bladder.
- Burning or stinging when you pass urine or pass urine frequently- this may be due to a urine infection. Treatment is with a course of antibiotics.
If you develop a painful red swollen leg, shortness of breath, chest pain or start coughing up blood, this may be a sign of a clot in the leg or lung.
In such cases you will need to be admitted to the hospital urgently.