Laparoscopy

Laparoscopy is a surgical procedure that examines and treats pelvic organs by using very small incisions in the abdomen.  This is possible because of the laparoscope (a long, slender tool with a camera and light), which lets the surgeon see inside the abdomen.  To perform the surgery, the laparoscope and other special instruments are inserted into the abdomen through the small incisions.  Laparoscopy is often used to diagnose and treat the causes of pelvic problems, such as pain and infertility.

Why the Procedure is Performed   

Laparoscopy is used both for diagnosis and treatment. It may be recommended for many reasons, including:

• Investigating infertility – searching for possible causes, such as endometriosis, cysts, or a blocked fallopian tube.
• Looking at and removing an abnormal pelvic mass previously found by other testing.
• Identifying the cause of pelvic pain – which can be caused by: 
  • Infections such as pelvic inflammatory disease.
  • Endometriosis, or uterine tissue found outside the uterus in the abdomen.
  • Ovarian cysts, which are fluid-filled sacs that attach to the ovaries.
  • Adhesions, or scar tissue in the pelvis.
• Hysterectomy, or removal of the uterus.
• Myomectomy, or removal of uterine fibroid tumors.
• Tubal ligation, a permanent method of birth control in which the surgeon uses the laparoscope as a guide and cuts or blocks the fallopian tubes.
• Surgically treating a tubal pregnancy.  A tubal pregnancy is also called an ectopic pregnancy, and it occurs when a fertilized egg attaches to a fallopian tube instead of traveling down the tube to the uterus.

The Procedure

The patient is usually given a general anesthesia and is asleep during the operation.  After the anesthesia has taken effect, one or more small (one-quarter to one-half-inch) incisions are made near the navel or the pubic hairline. A harmless gas is usually used to inflate the abdomen, giving the surgeon more room to see and work.The laparoscope is inserted through an incision, and sends images to a video screen nearby, which gives the surgeon a clear view of the organs.  The images can also be photographed to be examined later by the surgeon or others.  Often, additional instruments are placed in other small incisions; some allow the surgeon to gently manipulate the uterus in order to get different views throughout the procedure.  If treatment is found to be necessary, instruments such as lasers and electrosurgical instruments can be inserted and used to perform surgery at the same time.When the surgeon is finished, the instruments are removed, the gas is released, and the incisions are closed.  The patient is usually able to leave within a few hours, but is not advised to drive for at least 24 hours.

Recovery

Although recovery from laparoscopic surgery is much shorter than with abdominal surgery, it still may take up to two weeks.  During this time, the patient is advised to:

• Drink plenty of fluids
• Take pain medication only as prescribed by the physician
• Eat fruits, vegetables and other fiber-rich foods to avoid constipation
• Rest as much as possible

The physician’s advice should be followed as to when it is safe to:

• Return to work
• Lift weights of 20 pounds or more
• Exercise
• Have sexual intercourseThe patient needs to be sure that a follow-up visit is schedule to discuss the results of the procedure with the physician.

In the meantime, if any of the following symptoms occur, the physician must be contacted immediately:

1. Chills or a fever of 101°F or higher
2. A red, swollen or draining incision
3. Heavy or bright-red vaginal bleeding
4. A bad-smelling vaginal discharge
5. Severe abdominal pain or bloating
6. Difficulty urinating
7. Severe, persistent nausea or vomiting

Remember

There are many benefits to a laparoscopic procedure.  These include smaller incisions, less loss of blood, and shorter hospital stays as well as shorter recovery periods.