Laparoscopy in Gynecology
Laparoscopic surgery is performed using an instrument called a laparoscope, a thin, lighted telescope that is inserted through a tiny, ½ -inch incision made in the navel. The laparoscope allows a surgeon to see and operate in the abdomen without having to use a long incision. Two or three smaller incisions are made along the sides of the abdomen, to allow passage of highly specialized surgical instruments. Laparoscopic techniques allow surgery to be performed with fewer traumas to patients, and minimal damage to body tissues
With miniaturized instruments, doctor can perform a variety of surgeries.
Laparoscopy generally has a shorter healing time than open surgery. It also leaves smaller scars.
Reasons for Gynecologic Laparoscopy
Laparoscopy can be used for diagnosis, treatment, or both. A diagnostic procedure can turn into treatment.
Indications for diagnostic laparoscopy are:
• unexplained pelvic pain
• unexplained infertility
• history of pelvic infection
Conditions that might be diagnosed include:
• uterine fibroids
• ovarian cysts or tumors
• ectopic pregnancy
• pelvic abscess (pus)
• pelvic adhesions (painful scar tissue)
• pelvic inflammatory disease
• reproductive cancers
Types of laparoscopic procedures include:
• Hysterectomy (Removal of the uterus)
• Oopherectomy (Removal of the ovaries)
• Cystectomy (Removal of ovarian cysts)
• Myomectomy (Removal of fibroids)
• Laparoscopic uterine artery ligation (blocking blood flow to fibroids)
• Endometrial tissue ablation (endometriosis treatment)
• Adhesiolysis (separation of adhesion)
• Tuboplasty / reanastomosis (opening of blocked tubes)
• Burch procedure for incontinence of urine
• Sacrocolpopexy (vault suspension for vault prolapse)
Preparing for Gynecologic Laparoscopy
Preparation depends on the type of surgery. One will need imaging tests and relevant blood tests. You will be required to be fasting for 6-8 hours before the procedure. Tell your doctor about any medication you take. This includes over-the-counter drugs and supplements. You may need to stop them before the procedure.
Laparoscopy is almost always performed under general anesthesia. This means you will be unconscious for the procedure. However, you may still be able to go home the same day. The surgeon will make a small cut in your navel. The laparoscope will be inserted. It transmits images to a screen. This gives your doctor a clear view of your organs. What happens next depends on the type of procedure. For diagnosis, doctor might take a look and then be done. If you need surgery, other incisions will be made. Instruments will be inserted through these holes. Then surgery is performed using the laparoscope as a guide. Once the procedure is over, all instruments are removed. Incisions are closed with stitches. Then you will be bandaged and sent to recovery.
Recovery after Laparoscopy
Once the procedure is over, nurses will monitor your vital signs. You will stay in recovery until the effects of anesthesia fade. Recovery time varies. It depends on what procedure was performed. You may be free to go home a few hours after surgery. You might also have to stay in the hospital for one or more nights.
After surgery, your belly button might be tender. There may be bruises on your stomach. The gas inside you can make your chest and shoulders ache. There is a chance that you will feel nauseated for the rest of the day.
Before you go home, you will be given instructions regarding medication and side effects. Your doctor may prescribe pain medication. You may also receive antibiotics to prevent infection.
Depending on the surgery, you may be told to rest for a few days or weeks. Serious complications of laparoscopy are rare. However, you should call your doctor if you experience:
• serious abdominal pain
• prolonged nausea and vomiting
• fever of 101 degrees F or higher
• pus or significant bleeding at your incision
• pain during urination or bowel movements
Outcomes of Laparoscopy
The results of these procedures are usually good. This technology allows the surgeon to easily see and diagnose many problems. Recovery time is also shorter compared to open surgery. Patient experiences less pain in postoperative period. This procedure requires shorter hospitalization and there is less blood loss associated with laparoscopy.
Dr. Preeti Tandon,
Specialist Obstetrics / Gynecology
MBBS, MD(Obs/Gynae), F.MAS(Laparoscopic Surgeon), FICOG,
Diploma in Adv Gynae Endoscopy (France),
Certified Robotic Surgery Training (USA)