Laparoscopy

Diagnostic laparoscopy is an operation to see inside the abdomen (tummy) without making large incisions on the skin. It is also known as keyhole surgery. A small tube called a laparoscope is inserted into the abdomen usually through the belly button. If you have had surgeries before the doctor may decide to insert the tube higher up in your tummy under the left ribs.
The tube has a light and a camera showing images of inside the abdomen.

What are the reasons to perform laparoscopy?

Diagnostic laparoscopies are used to identify a cause for your symptoms and plan treatment. The operation will help to find out if you have any of the following conditions:
• Endometriosis ( cells lining the womb are found elsewhere in the body)
• Pelvic infection
• Scar tissue, for example from previous surgery
• Damaged fallopian tubes
• Ovarian cysts
•Removal of fibroids
•Removal of the uterus or hysterectomy
Commonly, we do not find any abnormalities during a diagnostic laparoscopy. If minor problems are found such as small areas of endometriosis or minor scar tissue, these can be treated during your operation. If more complex problems are found then they may need to be treated with another operation on another day.
The advantages of keyhole surgery include:
• Faster recovery and shorter hospital stay
• Less pain and bleeding
• Reduced scarring
laporoscopy

What happens before the operation?

You may require a pre-operative assessment.
You may need blood tests, chest X-ray or an ECG (if you have underlying chronic conditions or you are older than 60).
The doctor may ask you to stop certain medications – see more information on preparation for surgery here
You will be asked not to eat or drink anything for 6 hours before your operation.

What does the operation involve?

For this operation, you will need to have a general anaesthetic. The anaesthetist will talk to you in detail about this on the day of the procedure. Once you are asleep, your abdomen and vagina will be cleaned with pink or brown cleaning fluid. Your bladder may be emptied with a small tube (catheter) but this will not be present when you wake up. The surgeon will examine your vagina and abdomen to assess how big your womb is.
Often a small instrument is placed on the cervix (neck of the womb) to help move the womb during the operation. This will be removed before you wake up and may sometimes cause vaginal spotting. A small cut will be made on your belly button. The laparoscope is inserted through this cut and the abdominal cavity is filled with gas (carbon dioxide). A further small cut is made, so a ‘port’ can be inserted into your abdomen. A port is a small plastic tube that allows the instruments required for the operation to be inserted into the abdomen. Sometimes more than one port is needed. Your doctor will perform the discussed procedure – diagnostic laparoscopy to assess your tummy or removal of endometriosis, or cysts, or fibroids, or womb After the procedure, the gas is released from your abdomen and stitches are used to close the incisions. Dressings are usually placed over these wounds. The operation normally lasts 30-120 minutes.

What complications can happen?

A laparoscopy is a commonly performed procedure and serious complications are rare.
Minor complications occur in approximately 1 -2 out of every 100 cases following laparoscopy. They include:
• Wound infection or gaping.
• Urine infection.
• Minor bleeding and bruising around the incision.
• Shoulder-tip pain (caused by the gas used to inflate the abdomen).
• Feeling sick and vomiting.
Serious complications occur in about 2 women in every 1,000 (uncommon). They include:
• Damage to the bowel, bladder, uterus or major blood vessels which would require immediate repair. The repair may involve needing a bigger incision on the tummy. However, up to 15% (15 out of every 100) of bowel injuries might not be diagnosed at the time of laparoscopy.
• Failure to gain entry to the abdominal cavity and to complete intended procedure
• Hernia at the site of entry
• Serious allergic reaction to the general anaesthetic
• A blood clot developing in a vein, usually in one of the legs (deep vein thrombosis or DVT), which can break off and block the blood flow in one of the blood vessels in the lungs (pulmonary embolism).
• Death; 3-8 women in every 100,000 undergoing laparoscopy die as a result of complications (very rare).

What can I do to minimize complications?

Stopping smoking several weeks before your operation will reduce the risk of complications and the recovery time.
If you are overweight you have a higher rate of complications, particularly infection and clots in the lungs and legs.
Your risk of complications (bowel and bladder injuries, failure to enter the abdomen) is higher if you have had previous abdominal surgery
You can reduce your risk of wound infection by bathing or showering either the day before or on the day of your operation. It is advised that you don’t shave or wax the area where a cut is likely to be made.

Recovery

After your laparoscopy, you may feel groggy and nauseated. These are common side effects of the general anaesthetic and will pass quickly. A nurse will monitor you for a few hours. When you are up and about, eating and drinking and able to pass urine you will be able to go home. Most people go home on the same day. Some people stay in the hospital overnight especially if you had an operative laparoscopy.
You must not drive for 24 hours after diagnostic laparoscopy and at least 2 weeks after operative laparoscopy. Please arrange for someone to take you home and be with you for 24 hours after surgery. It is common to experience bloating and pain in your abdomen for a few days after your operation. Sometimes the pain may also affect your shoulder. This is a common side effect of the gas used in laparoscopy. Simple painkillers such as paracetamol and ibuprofen can be taken for this. You can shower within 24 hours of your laparoscopy and remove your dressings in a week. More dressings are not needed; simply keep the wounds clean and dry.
You should feel ready to return to normal day to day activities within 5 days. It is advisable to take a minimum of 5 days off work after diagnostic laparoscopy and 2 weeks after operative laparoscopy.

When to Seek Medical Advice

For questions in the first week after the operation, you can contact your doctor directly. If you become unwell in the week after surgery you must seek advice. If it is urgent, contact Dr Novikova on 0796807821 or your nearest Hospital Emergency Department. You should lookout for the following:
• Burning or stinging when you pass urine. This may be a urinary infection and
can be treated with a course of oral antibiotics.
• Red or painful skin around your scars. This may be a skin infection and can be treated with a course of oral antibiotics.
• A painful, red, or swollen leg. This may be a clot in the leg.
• Increased abdominal pain, vomiting and fevers. This may be a result of damage to the organs (for example damage to the bowel) and needs further tests in the hospital.
• Heavy vaginal bleeding (if you have had a hysterectomy) may be a sign of vaginal vault dehiscence or Hematoma (collection of blood in the pelvis) and will need urgent assessment and an intervention

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