Laparoscopy

What is laparoscopy?

Laparoscopy is a minimally invasive surgical procedure performed by using a laparoscope, a thin fibre-optic instrument with a camera and lens attached on the end. The laparoscope can be used for diagnosing and treating various conditions.

What are the gynaecological conditions that can be treated using a laparoscope?

Laparoscopy can be performed to assess the reproductive organs, and diagnose and treat

  • Cause of infertility
  • Chronic pelvic pain
  • Presence of fibroids, polyps, cysts and tumours
  • Endometriosis
  • Ectopic (tubal) pregnancies
  • Pelvic inflammatory disease
  • Pelvic abscess or pus
  • Pelvic adhesions (scar tissue)

What are the types of gynaecological laparoscopic treatments?

Laparoscopy can be diagnostic or operative, or both:

  • Diagnostic laparoscopy: A laparoscopy is diagnostic when the surgeon is viewing the abdominal cavity and pelvis to make a diagnosis, without any treatment administered at that time. This is particularly useful when other tests such as X-rays, scans or blood work are inconclusive. The laparoscope is usually smaller as no channel is needed for surgical instruments.
  • Operative laparoscopy: A laparoscopy is considered operative when the surgeon is treating a problem that is found during diagnostic laparoscopy.
  • If your surgeon sees an opportunity to treat a problem during a diagnostic laparoscopy, an operative laparoscopy will usually be performed at that time depending on the patient’s condition and the surgeon’s preference.

Some types of gynaecological laparoscopies are:

  • Hysterectomy (removal of uterus)
  • Removal of the ovaries and ovarian cysts
  • Removal of fibroids
  • Blocking blood supply to fibroids
  • Ablation of endometrial tissue
  • Removal of adhesions
  • Tubal ligation reversal
  • Burch procedure to treat incontinence
  • Vault suspension to correct a prolapsed uterus

Am I candidate for laparoscopy?

Laparoscopy is usually recommended for most patients because it is less invasive. However, you may not be a candidate for laparoscopy in the following cases:

  • Obesity (increased abdominal thickness)
  • Previous abdominal surgery
  • Presence of abdominal scars
  • Suffer from umbilical hernia
  • Have hemodynamic instability (unstable blood pressure)

How do I prepare for laparoscopy?

Preparation may be different for each type of laparoscopic procedure. However, the general steps may include diagnostic tests to identify the problem, fasting or enema to clear your system, and specific instructions given on the medications that you can continue to take and those you would need to stop.

How is laparoscopy performed?

Laparoscopy is usually performed under general anaesthesia. During the procedure, your surgeon makes a small incision in the abdomen, usually at or below the belly button, and inserts a port through which the laparoscope is introduced into the abdomen. The light source and camera illuminate the surgical region and relay images onto a large screen for your surgeon to view. A special contrast dye may also be injected before the procedure for better visualisation of the fallopian tubes or carbon dioxide gas passed into your abdomen to improve visualisation.

If a treatment is being performed, small surgical instruments are inserted to treat the condition. Throughout the entire surgery, the laparoscope will guide your surgeon. Once the procedure is complete, the surgical instruments and laparoscope are removed. The incisions are then closed with stitches and covered with bandages.

Laparoscopy

Laparoscopy

What can I expect after laparoscopy?

Laparoscopic surgeries are usually outpatient procedures. You will be monitored for a few hours until you are awake and can eat, drink and pass urine. Then you will be allowed to go home. However, some surgeries may require an overnight stay. Depending on the type of surgery performed, you will be given specific instructions on your care.

Describe the stages of recovery.

Following the surgery, you may experience pain for which your doctor will prescribe pain medication. You may also experience cramps, bloating and shoulder pain as a result of the carbon dioxide gas that was used to inflate your abdominal cavity; this will resolve within a few days.

Consult your doctor immediately if you experience any of the following:

  • Fever
  • Pain that gets worse
  • Heavy vaginal bleeding
  • Swelling, redness or discharge from the incision
  • Inability to empty your bladder
  • Fainting

What are the advantages of laparoscopic surgery?

The advantages of laparoscopic surgery when compared to the traditional open surgery are:

  • Smaller incisions
  • Less post-operative pain and discomfort
  • Faster recovery
  • Shorter hospital stay
  • Earlier return to normal activities
  • Smaller scars
  • Minimal internal scarring

What are the potential complications of laparoscopy?

As with any surgical procedure, laparoscopy may be associated with certain risks and complications such as:

  • Infection
  • Bleeding
  • Blood clots
  • Damage to other organs or major blood vessels
  • Hernia formation
  • Urine infection

Sometimes, your doctor may have to change to an open surgery if there is any complication during the laparoscopic surgery.

What is the downtime of laparoscopy?

You will be able to get back to your usual routine within two to three weeks.

What is the cost of laparoscopic surgery?

Any costs involved will be discussed with you prior to your surgery.

What is the current research regarding laparoscopic surgery?

Extensive research is being done to find better treatment outcomes of laparoscopic surgery. Some of the recent studies are listed below:

  • Melamed A, Nitecki R, Boruta DM 2nd, et al. Laparoscopy Compared With Laparotomy for Debulking Ovarian Cancer After Neoadjuvant Chemotherapy. Obstet Gynecol. 2017 May;129(5):861-869.