Laparoscopy

What is a laparoscopy (Keyhole surgery)?

A laparoscopy, also known as keyhole surgery, is an investigation/operation to look inside your abdomen (tummy), using a small telescope. You will be given a general anaesthetic and when you are unconscious, an instrument will be passed through a small cut (5mm) in the abdominal wall usually through the umbilicus (belly button).

Why is a laparoscopy performed?

A laparoscopy is a diagnostic procedure which allows the surgeon to get a good view of your womb, tubes, ovaries and other parts of the pelvic region. Treatment to scar tissue (adhesions), endometriosis, and removal of ovarian cysts, ovaries and even hysterectomy can be performed through the keyhole (Laparoscopic surgery), in the appropriate patient. Often one or 2 small incisions are made lower down so that operating instruments can be used to gently move things around to obtain a better view and to perform the necessary operation.

Indications for laparoscopy:

  • Ovarian cysts
  • Endometriotic chocolate cysts
  • Dermoid cysts
  • Release of adhesions (adhesiolysis)
  • Ovarian Drilling for PCOS
  • Investigation and treatment of infertility
  • Chronic Pelvic Pain
  • Chronic Pelvic Inflammatory Disease (PID)
  • Female Sterilisation
  • Tubal disease
  • Oophorectomy (removal of ovaries)
  • Salpingectomy removal of fallopian tubes)
  • Hysterectomy

Are there any risks with the procedure?

Laparoscopy is a safe procedure, but like any other operation, comes with some small risks. There may be a risk of needing an open operation (laparotomy) in the event of a complication such as bleeding, damage to nearby organs, for example bladder or bowel injury. There is a small risk of wound infection, bleeding needing blood transfusion or thrombosis. All precautions are taken to perform the operation as safely as possible. Complications occur in less than one in thousand cases, unless there are other risk factors, such as previous abdominal surgery. After the operation, most women recover usually within a week. If however, you start feeling unwell or have concerns, you must contact the hospital where you were operated, so that you can receive the correct medical advice.

How long will I stay in hospital?

You will be discharged home either the evening of your operation or the following morning – dependent on how you feel. If you have major keyhole surgery, you may stay in the hospital for 2-3 days.

Do I need to fast before the operation?

Yes, if you are having a General anaesthetic, no food, even chewing gum for at least 6 hours before your procedure.

Evening Operation: No food or chewing gum after 10 am in the morning. You can drink water up to midday.

Morning Operation: No food or chewing gum after midnight before your procedure. You can drink water up to 6 am of the morning of your procedure. Please take your essential medications as normal with a sip of water, unless advised by nurse or doctor.

Do I need to stop my medications before my procedure?

You normally should not stop any of your essential medications. Please take your usual essential medications with a tiny sip of water at the regular time. Do remember to bring a list of all your medications to show the nurse at your pre-assessment (if you are having one) and also let your admitting nurse and anaesthetist know all the medications you are on. This is because your medications may influence your anaesthetic and surgery. You should also inform the nurse and anaesthetist of any allergies that you have to foods, metals, drugs etc. Some important notes on certain conditions are listed below.

DIABETES (insulin or tablet)

In general you should not take your insulin injection or your tablet, when you are fasting. For example, if your operation is in the morning, DO NOT TAKE your morning dose or injection as you will be fasting overnight, but do take the previous dose as normal. If your operation is in the evening, take your doses as normal in the morning, but stop injection/tablets if you are taking any at lunchtime (you will fast for 6 hours, usually after 10 am).You can resume your normal regime, once you are eating and drinking normally. If in any doubt, consult your surgeon or anaesthetist.

ASPIRIN, WARFARIN, CLOPIDOGREL, CLEXANE or any blood thinning agent

You will need to stop most blood thinning agents such as Aspirin or Clopidogrel at least 1-2 weeks before your procedure. This is to avoid excessive bleeding at your operation. If you are on Warfarin or Clexane, you will need to liaise with your surgeon and cardiologist. If in any doubt, consult your surgeon or anaesthetist and certainly inform them when you see them, as it may influence your management.

Will I have stitches?

You will have a couple of dissolvable stitches, one in your umbilicus (belly button) and one or two just below, either to the right or left of your abdomen. These will dissolve in approximately 10-14 days. You will not need a dressing, once you take off the ones covering the scars when you leave the hospital.

What can I expect after a Laparoscopy?

  • Nausea – You may feel slightly nauseated or groggy just as you are coming out of your anaesthetic. This will pass soon and if needed, medication will be given to you to make you feel better. You will be able to resume normal activities soon.
  • Vaginal bleeding – Some amount of vaginal bleeding and discharge is to be expected, usually for a week or so. As long as this is not heavy, or has an offensive smell or causes you concern, this is normal. There may be blue staining if a dye has been used to test your fallopian tubes (fertility test). It is usual to have some slight bleeding after a laparoscopy, as instruments are used in the vagina to move the womb. and you may need to wear a sanitary towel for a few days. Avoid tampons, usually for 2 weeks after the procedure, to reduce risk of infection.
  • Abdominal distension, wind and shoulder-tip pain Abdominal distension is fairly common after a laparoscopy accompanied by shoulder-tip pain. This is due to gas that has been inserted into the abdomen (tummy) so that the abdomen will distend (rise), thereby allowing easier viewing of the pelvic organs. This bloated feeling, wind and shoulder-tip pain is temporary and will resolve itself in approximately 24-48 hours, as the gas gets re-absorbed into your system. Early mobilisation will help to increase the re-absorption process. The pain is relieved by taking your usual painkillers or medication prescribed by the hospital. Some women may need stronger pain killers.
  • Wound pain – For a few days after your operation, you will have a feeling of soreness on the abdomen. This is normal and should not cause concern. Pain killers such as Paracetamol or Ibuprofen are usually effective in controlling discomfort.
  • Other issues: Bathing You can have a shower or a bath when you feel able. Dry the stitches carefully. Do not use talcum powder in this area. Take off the dressings and leave to air. There is no need to cover the scars. Work You should be able to return to work after approximately a week – taking into consideration the type of work you do. However, if you have made keyhole surgery, you will be advised by your doctor how long you need to be off work. Lifting Mobilise as normal, but do not do any heavy lifting for 3-4 days.
  • Sex – You will be able to resume sexual intercourse when you feel comfortable. If you are bleeding, wait for this to stop. If you are not bleeding, go ahead when you feel comfortable.
  • Other physical activities – You will be able to resume other activities such as sport and swimming as soon as you feel able.

When will I know the results of the laparoscopy?

Following your laparoscopy, the findings and their implications will be discussed with you. Plans will be made for any further treatment and any necessary appointments will usually be made before you leave the hospital. The results of any biopsy taken take about a week to come back. You will usually be seen in clinic for a follow up or have the results communicated to you. If you need further surgery or other treatment, this will be discussed in detail with you, usually in the clinic. Your GP will be sent a letter with the findings from your procedure, and any results. You can be copied into this, if you so wish.

Nitu Bajekal (Consultant Gynaecologist, Feb 2009)