Laparoscopy
Dr G.D. Reid & Dr H.F. Joyce
The laparoscope is a telescope used to examine the abdominal cavity and pelvis. A camera is attached to the end of the laparoscope, transmitting a high quality image to a video monitor, thus allowing the doctor to see organs and structures within the abdomen and pelvis.
The Purpose of Laparoscopy
This examination may be done for diagnosis of a problem in the presence of symptoms, or to perform operative procedures within the abdomen / pelvis.
1. Diagnostic laparoscopy
This is most commonly performed in the presence of:
- Abdominal / pelvic pain
- Severe period pain
- Infertility
Sometimes a biopsy or sample of tissue is taken for examination by the Pathologist.
2. Operative laparoscopy
- Sterilization
- Removal of ovarian cysts or the entire ovary
- Removal of an ectopic or tubal pregnancy
- Treatment of endometriosis
- Removal of abdominal or pelvic adhesions (scar tissue)
- Removal of uterine fibroids
- Hysterectomy
- Bladder neck surgery
It is impossible to list all the procedures which may be undertaken with the aid of laparoscopy, but those listed are the most common ones being performed laparoscopically at the present time
The Operation
At present, laparoscopy is always performed under general anaesthetic, and therefore requires admission to hospital or a day surgery unit.
The laparoscope is introduced through a small incision in the umbilicus (navel), after which the abdominal cavity is filled with carbon dioxide to lift the abdominal wall away from underlying organs. Between one and four additional entry sites are then made depending upon the complexity of the operation being performed. Each of these measures from 0.5 - 1.0 cm.
The duration of the operation depends upon the procedure being performed, with a simple diagnostic laparoscopy usually taking about 10 - 15 minutes. Photographs or video recording of the procedure is usually undertaken for inclusion in the medical record, for communication with your GP and to be able to explain the findings to yourself at the follow-up visit.
After the instruments have been removed and the carbon dioxide gas released, dissolving stitches are placed in each incision site. After complex surgery, a thin drain tube may be left in the abdominal wall for the first 24 hours.
After the Operation
After diagnostic laparoscopy or simple operative laparoscopy, it is usual to leave hospital on the same day. After more complex surgery, a 24 - 72 hour hospital stay may be involved.
If day surgery is undertaken, you would need to be picked up by a friend as you should not drive or operate machinery for 24 hours after any anaesthetic.
It may be necessary to take some simple analgesics for cramps or abdominal pain afterwards, and it is normal to have some light bleeding or discharge for a few days after the operation. It is normal to feel tired and fatigued for the first few days, to feel pain around the site of the incisions, and commonly to feel an ache in the shoulder as the carbon dioxide gas may cause some irritation of the diaphragm which causes pain in this area.
You should however continue to feel better each day. While there are no specific limitations on your activity, a quiet time for the first few days after operation is sensible. Sexual activity should be avoided until any bleeding or discharge ceases.
Risks of the Operation
Like any surgery, there are risks associated with laparoscopy.
These risks include:
- Excessive bleeding requiring transfusion, or conversion to an open operation.
- Perforation of other structures including bowel. Generally this can be repaired at the time of operation but in rare circumstances can require temporary colostomy (diversion of bowel to a bag)
- Ureteric injury requiring further surgery to repair.
- Bladder injury which would need catheter drainage for 7 days after the operation.
Conclusion
There are clear benefits that result from operations performed with the aid of the laparoscope. It is nevertheless important for you to discuss any proposed procedure with your doctor, and feel free to ask any questions that you may have. An understanding of the benefits and the risks in your own case is most important.
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Last updated 24th November, 1998