Minimally invasive surgery - Laparoscopy

To diagnose or treat certain pelvic problems, your physician needs to look directly into the abdomen at the reproductive organs. This can be done with laparoscopy.

 

The word laparoscopy comes from the Greek words that mean "look into the abdomen." A laparoscope is a small telescope that is inserted into the abdomen through a small incision (cut). It brings light into the abdomen so the doctor can see inside. Laparoscopy is usually done on an outpatient basis, so you don't have to stay in the hospital overnight.

 

There are several reasons why laparoscopy may be recommended. If your doctor suspects that you have a certain problem, he or she may use laparoscopy to confirm the diagnosis. This is called a diagnostic laparoscopy. We may use this procedure to evaluate potential causes of infertility, pelvic pain, and pelvic masses first identified at the time of an office examination or on ultrasound. Besides using the laparoscope to look into the abdomen to diagnose a problem, your doctor can use it for treatment as well. For many years, gynecologists have been using laparoscopy to perform permanent sterilization by tubal ligation and remove causes of pelvic pain such as scarring or endometriosis. Improvements in technology now permit far more sophisticated procedures such as the removal of the ovaries, the fallopian tubes, and even the uterus and large tumors.

 

Consequently, for many operative procedures laparoscopy has replaced the need for laparotomy. Laparotomy involves opening the abdomen with an extensive incision to operate on the reproductive organs.

 

Procedure

You will go to sleep with general anesthesia before the doctor begins the laparoscopy.

 

A small incision is then made below or inside the navel. Carbon dioxide is put into the abdomen. The gas swells the abdomen so the pelvic reproductive organs can be seen more clearly. Your body will be tilted slightly with your feet raised higher than your head. This shifts some of the abdominal organs toward the chest and out of the way.

 

The laparoscope is placed through the incision. Another incision is often made within the region of the pubic hair. Through this second incision, an instrument is placed to move the organs into view. One to four small incisions may be made in all, each 1/4" to 1/2" wide and serving as ports for operative instruments. In addition, an instrument may be placed in the uterus through the vagina as well in order to move the uterus during the procedure. Usually, the laparoscope projects images of the surgery onto a television screen. This makes the image larger and easier for the surgeon to see.

 

Other surgical instruments can be inserted through these ports. These instruments include:

• Mechanical surgical instruments, such as scissors, forceps, and clamps.
• Electrosurgical instruments that use electric current to cut and cauterize tissue.
• Lasers that use a high-energy light beam to perform the same procedures as electrosurgery.
• Specimen bags and morcellators that allow removal of surprisingly large growths or masses.
  

 

After the procedure, the instruments are removed and the gas released. The incisions are then closed, usually with stitches that dissolve or skin glue. Normally, in a few hours you can go home. You should plan to have someone take you home and stay with you, at least for a day or two.

Possible problems

Although problems seldom occur with laparoscopy, there can be some complications. You may have some bleeding, reactions to the anesthesia, or injury to other organs. The most common organs injured during the procedure are the blood vessels that surround the lower abdomen, the bowel, and the urinary tract. Should a significant complication be identified either during the laparoscopy or later, a subsequent laparotomy may be needed. In that case, you will require admission to the hospital. There is also a risk of infection after the procedure.

More common problems include:

• Nausea
• Pain around the cuts made in your abdomen
• Scratchy throat if a breathing tube was used during general anesthesia
• Abdominal cramps
• Discharge (like your period) that lasts a few days
• Swollen abdomen
• Tender navel
• Shoulder pain

Call your doctor if you are bleeding from the incision, if you have a fever, or if you are unable to urinate.

Recovery

The recovery time from laparoscopy is much shorter than that from regular surgery. It is safe to resume normal activities as soon as you feel up to it, usually within a few days. If you are sexually active, talk with your doctor about when you can have sex again.

 

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