Laparoscopy

What is a laparoscopy? It is an operation to look at the pelvic organs (womb, fallopian tubes and ovaries). A thin telescope (laparoscope) is inserted into the abdomen under a general anaesthetic. It is usually performed as a day case ie. you are admitted and discharged on the same Day. How is it performed? Two small incisions are made, one within the umbilicus (belly button) and the other lower down, just above the pubic bone. The incisions are usually 1cm (half an inch) long. The abdomen is inflated with carbon dioxide before the laparoscope is inserted. A third small incision is sometimes made if extra surgery is required (see below). A dissolving stitch is placed in each incision. What else can be performed at the same time? Sterilisation - Clips can be applied to the fallopian tubes. Dye test - This may be performed in women with subfertility to see if the fallopian tubes are blocked. Blue dye is injected through the cervix and the tubes are observed to see if the dye passes through. Treatment of endometriosis - Endometriosis is a common cause of pelvic pain and infertility, and is commonly seen as black or red spots in the pelvis (see photograph). It can be treated using laser or by excision, depending on the position and extent of the disease. It is not always suitable for treatment, but where it can be performed, hormonal treatment may be avoided. Division of adhesions - Adhesions are bands of tissue that form between two structures, usually due to previous infection or surgery. Although often without symptoms, they may cause pain or infertility. They can be divided using special scissors. Other major surgical procedures can be performed laparoscopically including hysterectomy, sacrocolpopexy and hysteropexy for prolapse and colposuspension for incontinence.

Professor Christian Phillips BSc Hons BM DM FRCOG Consultant Gynaecologist and Urogynaecologist

Image of endometriosis:

Does laparoscopy have any risks? All operations have risks. The main risk with laparoscopy is injury to the bowel, bladder or blood vessels within the abdomen. In approximately 1 in 500 cases, a proper incision needs to be made in order to repair such an injury. The risk of significant injury is increased when keyhole treatment is performed at the same time, and this risk must be carefully balanced against the expected health benefits of such treatment. The risk of a serious complication is also increased in women who are obese or who have had previous abdominal surgery. Between 3 and 8 women in every 100,000 undergoing laparoscopy will die as a result of complications. During laparoscopy an instrument is inserted through the cervix into the womb in order to move it around and get a full view of the pelvis. A small hole can occur in the womb (perforation) during this part of the operation. This is rare and occurs in less than 1% of cases but this is very rarely serious. An overnight stay in hospital may sometimes be advised if this was to occur. What can I expect after the operation? You may notice some pain in your shoulders. This is due to the carbon dioxide used to inflate the abdomen. Pain killers will be given if you need them. Nausea is common due to the anaesthetic. Bruising may occur around the incisions. You will not be able to drive a car for several days. After discharge from hospital it is usual to have some abdominal pain and you may need to take pain killers for up to a week. Paracetamol or ibuprofen are usually sufficient. The stitches can take several weeks to dissolve. You may want to get them removed after one week by your GP's nurse. Helpful contact numbers: The ward will give you contact details for the hospital and ward, which you can call if you experience any difficulties/problems. If you are unable to contact the ward please ring Professor Phillips’ secretary on: 01256 377696. References Diagnostic Laparoscopy Consent Advice. RCOG. October 2004.