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WHAT IS LAPAROSCOPY?


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05/12/2010

WHAT IS LAPAROSCOPY?

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Written by: Kathryn Danzey

What is laparoscopy?

This procedure is also known as key-hole abdominal surgery and is a way of looking into your abdomen. Laparoscopy can be used for diagnosis, e.g. infertility, causes of pelvic pain such as endometriosis, pelvic infection and adhesions. It can also be used for treatment of a number of conditions such as endometriosis, adhesions, ectopic pregnancy, removal of ovarian cysts or ovary and achieving sterilisation.

How is it done?

At least two small cuts are made, one just below the tummy button (naval, or umbilical) and one above the pubic hair line. A needle is passed through the skin into the abdomen close to the umbilicus and the abdominal cavity is filled with carbon dioxide gas to create a space, thus enabling the surgeon to gain a clear view. A small cut is then made into the skin, followed by insertion of the laparoscope (diameter 10 mm) – a fibre optic telescope instrument which permits the abdominal and pelvic cavity to be inspected. If other instruments are being used, they are inserted through additional small incisions (5 mm) in the tummy below the bikini line.

If the laparoscopy is being performed for diagnostic purposes it could take 20 minutes. If the laparoscopy is being performed for treatment purposes it will take longer. Laparoscopy, whether for diagnostic purposes or treatment, is usually performed under a general anaesthetic.

What sort of surgery is performed via the laparoscope?

Nowadays many different types of gynaecological surgery may be performed via the laparoscope – commonly referred to as “key-hole” surgery. The list includes:

Sterilisation
Removal of ectopic pregnancy
Removal of adhesions (scar tissue)
Diathermy/removal of endometriosis
Removal of ovarian cyst or ovary
Unblocking Fallopian tubes
Removal of a damaged Fallopian tube
Removal of fibroid
Hysterectomy
Nerve block to alleviate chronic pelvic pain
Correction of tilted or prolapsed uterus

What sort of surgery will I have?

If the underlying cause of your problem has been clearly identified, the nature of the surgery will have been discussed. Sometimes, the precise nature of your problem is only established at the time of the laparoscopy. Therefore, the exact nature of the surgery will be determined only at the time of the laparoscopy. This is the reason why, when you sign the consent form, the surgery is often referred to as “laparoscopy +/- pelvic surgery”. Mr Li will have given you an idea of what sort of problems may be encountered and the type of surgery which may be carried out. Please feel free to talk with Mr Li prior to the operation if you are uncertain what will or will not be carried out.

Occasionally something unexpected may be discovered during laparoscopy which is best dealt with via, or necessitate, open surgery (laparotomy). You should make it clear if you do not wish to proceed to laparotomy in any situation other than emergency.

Is laser energy used in laparoscopic surgery?

Not nowadays. Laser energy used to be employed to facilitate laparoscopic surgery but this is no longer used in Sheffield as there are now safer instruments using sophisticated mechanical and electrical designs available for laparoscopic surgery.

What are the advantages?

The advantages of laparoscopic surgery include a quicker recovery from the surgery itself, reduced time spent in hospital (patients usually go home within 24 hours) and smaller scars.

Another important advantage of laparoscopic surgery is that both diagnosis and treatment (surgery) can be carried out at the same time. If an abnormal condition is detected during the diagnostic procedure, surgery can often be performed to correct it at the same time therefore avoiding the need for a second anaesthetic.

Does it matter if I am menstruating at the time of the operation?

No, it does not matter in the vast majority of cases. Mr Li will have let you know if it is important to avoid menstruation at the time of the surgery.

How could I be sure that I am not pregnant at the time of the operation?

If your period is late and there is a chance that you could be pregnant you ought to let Mr Li or the nursing staff know. A bed-side urine pregnancy test could be performed immediately and the result available within a few minutes. If you are not overdue, you could still request a pregnancy test if you want to ensure that you are not pregnant. There remains a small possibility that you could have ovulated, the egg has been fertilised, but you are not yet overdue and the pregnancy test is negative. In this situation there is as yet no test which could help to find out that it has happened. In theory, the situation could be avoided if the laparoscopy is carried out within the first 10 days of the menstrual cycle. Most gynaecologists do not feel it is necessary to do so but if you feel otherwise please let Mr Li know prior to the operation so that he could make the special arrangements for you.

What are the complications of laparoscopic surgery?

All surgical procedures carry with them a small risk of complications and laparoscopic surgery is no different in this respect. The main complications are:

Hemorrhage, i.e. difficulty in controlling the bleeding

Perforation of the bowel or damage to the bladder or ureters

It is very rarely necessary but sometimes a more major operation (laparotomy) or even a hysterectomy may take place if severe complications do occur.

Every effort is made to minimise the risk of these complications and they are in fact quite rare. Certain complications may be more likely in some individuals. For example bowel injury is more prone to occur in women who have had repeated laparotomies (especially bowel surgery) resulting in the formation of adhesions between the bowel and the abdominal wall. In this situation conventional open surgery (laparotomy) may be preferred.

Postoperative instructions

Wound?A small amount of oozing from the wound, especially over the one beneath the umbilicus (naval) is not unusual and often settles on its own or with a pressure dressing. Occasionally, a few days after the operation a small amount of wound discharge associated with wound pain/discomfort may signify an infection; in this case you should seek help from your GP or Mr Li to treat it with a course of antibiotics.

Sutures?The sutures will, if left alone, normally dissolve within 2-3 weeks following the operation. However, if you find them irritating you may contact the practice nurse of your GPs surgery and arranged for them to be removed 5-6 days after the operation

Bath/shower
You can have a bath or shower the day after your operation. The dressings covering the small cuts can be removed at this time and the cuts cleansed and dried. There is no need to cover them with another dressing unless the wounds are uncomfortable next to clothing or they are oozing slightly.

Vaginal bleeding?You may expect some vaginal bleeding following your operation and this may last for anything up to two weeks. During this time it is advisable to use sanitary towels in preference to tampons and to remember to change them frequently (tampons may increase the risk of infection).

Pain?It is common to experience some pain or discomfort following the procedure. Shoulder pain is common as a result of distending the abdomen with gas (which irritates the diaphragm and produces referred pain to the shoulder), but this will gradually disappear over the next 24-48 hours. Abdominal pain will usually be relieved by simple analgesic such as paracetamol, paracodol or something similar. The pain may seem more severe at some times than others but it should progressively improve with time. PLEASE CONTACT MR LI OR THE HOSPITAL IF THE PAIN GETS SUDDENLY OR PROGRESSIVELY MORE SEVERE. Pain after keyhole surgery should never get worse and you should seek help if it does.

Returning to work?It very much depends on the individual and the type of work you do. After a diagnostic laparoscopy it is usually possible to return to work after two days. If you underwent laparoscopic surgery, e.g. diathermy of endometriosis or removal of ovary/ovarian cyst, you may need to be off work for 1-2 weeks.

Driving?After a diagnostic laparoscopy, you should not drive for at least 24 hours; following laparoscopic pelvic surgery you should avoid driving for about a week.

Others:?If you are concerned about your recovery in any way please do feel free to contact the hospital or Mr Li. Often a brief chat over the phone will be enough to reassure you but if there is a problem it is always easier to deal with it at an early stage.

DISCHARGE ADVICE AND GUIDELINES FOR THE FIRST 24 HOURS FOLLOWING ANAESTHETIC AND DIAGNOSTIC LAPAROSCOPY

DO NOT use public transport to go home from hospital or within the first 24 hours whether you are accompanied or not
DO NOT take alcohol or sedative drugs
DO NOT give yourself the responsibility of looking after your children or other adults
DO be accompanied home in a car or taxi and someone needs to accompany you overnight
DO get as much rest and sleep as you can
DO feel free to contact Mr Li or the hospital if you are worried or you have excessive pain, bleeding, nausea or sickness.

Prof T C Li
Consultant Gynaecologist
7 Williamson Road
Sheffield S119AR
Tel: 0114 2550365
March 2007



About the Author

Kathryn Danzey
I have a passion to bring to you what really works in the beauty industry, from a moisturiser to the latest advanced treatment for anti ageing. After almost 4 decades in the industry I'm packed with info to share but never tire of looking for new things and would love you to share your experiences with us too. We're here to help you find that treatment or product that will make a change for you. Can't do without Moisturiser with sun protection, microdermabrasion and pedicures





 
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