Laparoscopy – What is it?
Laparoscopy is a minimally invasive surgical procedure that can be used to diagnose and treat many abdominal and pelvic problems. Laparoscopy is also commonly known as ‘keyhole surgery.’ The laparoscope is a specialised telescope which is passed through the abdomen into the abdominal cavity allowing the surgeon to look inside as well as operate inside the abdomen and pelvis. Diagnostic laparoscopy is the term used when the laparoscope is used to make or aid in making a diagnosis. Operative laparoscopy describes a number of different procedures where the laparoscope is central to operating within the abdominen and pelvis.
The technology continues to involve but is already at the point where many surgical procedures that, in the past, required open surgery (laparotomy: single large incision through the abdomen) are conducted using a few small (5-10mm) incisions in the abdomen. Diagnostic laparoscopy allows a direct view of the abdominal and pelvic contents , their relationships with each other and any condition that might explain the patient’s symptoms. A pre-planned surgical procedure can then be carried out using laparoscopic instruments. If appropriate consent has been previously obtained, laparoscopic treatment can be carried out if, during diagnostic laparoscopy, pathology is found.
Indications for diagnostic laparoscopy
- Abdominal and pelvic pain
- Painful intercourse
- Abdominal and pelvic masses or tumours
- Menstrual problems
Preparation for laparoscopy
Laparoscopy is normally performed under a general anaesthetic in the operating theatre. There will be specific instructions on eating, drinking, which of your usual tablets you can take prior to surgery and which tablets you need to stop and when. You will be informed of what time to arrive at the hospital. You will be required to sign a consent for surgery form before any premedication or anaesthesia. When you arrive at the hospital, make your way to the admissions desk and from there you will be guided onto the ward and admitted by nursing staff. You will usually see your surgeon prior to having your anaesthetic and have the opportunity to ask any outstanding questions.
As with any form of treatment it is important that you understand why you are having your surgery and the parameters of that surgery. You will find that you will be asked to confirm your name, date of birth, intended surgery and name of your surgeon when you arrive at the hospital, when you are transferred to the ward, when you arrive at the operating theatre and again just before anaesthesia is administered.
Once out of theatre
- Routine post surgery nursing observations in the recovery area.
- Transfer to either the day procedure ward or to the inpatient ward.
- Drugs as required to control any pain or nausea.
- Removal of any catheters, drainage tubes or IV cannula’s before you go home.
- Diagnostic laparoscopy is usually done as a day procedure. Only 1 in 40 patients will stay in overnight because of problems such as pain and nausea.
- Operative laparoscopy can be day case or require admission depending on its’ nature.
- Arrange for a relative or friend to collect you from hospital.
Examples of operative laparoscopy
- Removal of tubes and ovaries
- Adhesion management
- Tubal occlusion
- Surgery for urinary incontinence
- Surgery for prolapse
- Treatment of endometriosis
In the operating theatre
- Position on back in lithotomy or modified lithotomy position
- Abdomen and vaginal areas cleansed
- Surgical drapes applied
- Bladder emptied
- Uterus (if present) instrumented to allow it to be moved
- Small incision in umbilical area
- C02 insufflated into abdomen, optical entry or cut down to pass laparoscope into abdomen
- Other small incisions made as required and other instruments passed
- Inspection of abdomen and pelvis
- Proceed to operative laparoscopy if indicated
- Check for haemostasis and exclude injury to organ or vessels
- Remove instruments and expel gas
- Wounds closed with skin glue or with dissolving stitches
- Reverse anaesthetic
- Transfer from operating theatre to recovery area
For at least 24hrs after surgery (Always confirm with your surgeon):
- Do not drive or operate any heavy machinery for at least 24 hrs
- Do not consume alcohol for the remainder of the day
- Do not sign any legal documents or make any important decisions
- Do not engage in sports or heavy lifting.
- Stay in the company of a responsible adult
- You should be able to return to work the following day, but may require more time off work depending on the procedure performed
- It is normal to expect some abdominal and pelvic discomfort. For pain control, you may use pain killers as ordered by your doctor
- Shower rather than bath
- Use sanitary pads and not tampons
- Rinse any wounds gently with water
Uterus and ovaries
Corpus luteal cyst
Pouch of Douglas
Division of adhesions
Pelvic floor suspension
Puncture ovarian cyst
Application of Filshie clip
Exposure vaginal vault
Risks associated with laparoscopy
Intra-abdominal injury involving:
- Bowel (≤ 1%)
- Bladder (1-1.5%)
- Ureter (≤ 1%)
- Haemorrhage/Blood transfusion (≤ 1.5%)
- Pain and discomfort in the lower abdomen
- Shoulder tip pain
- Constipation (common but temporary)
- Wound or bladder infection (2-4%)
- Haematoma (blood collection) (1-2%)
- DVT/PE (0.2%)
Notify your doctor if you:
- Feel unwell.
- Suffer ongoing nausea/vomiting.
- Develop an offensive wound discharge.
- Experience abdominal pain that is not settling.
- Have a raised temperature or signs of fever.
- Develop signs of a urinary tract infection.
- Avoid sexual intercourse, taking a bath, using tampons and swimming for two weeks after surgery. This time frame may increase if you have also had vaginal surgery. Please consult your doctor.
- In most cases you should be able to return to work and drive 24 hours after surgery. It is important that you confirm this with your doctor and your insurance company. If you operate machinery at work then take some advice about this.
- Make sure you have a followup appointment with your doctor to discuss the results of your investigations and the plans for further management if required.