Laparoscopic Surgery

What is laparoscopy?

Laparoscopy is a minimally invasive outpatient surgical procedure utilized to diagnose and treat a variety of infertility and gynecological conditions including pelvic pain, uterine fibroids, endometriosis, pelvic adhesions, tubal pregnancy, ovarian cysts and tubal disease. During laparoscopy a thin fiber-optic tube, attached to a video camera, is inserted into the abdomen, through a small incision in the belly button. It gives the surgeon a clear view of the uterus, ovaries and tubes on a high definition monitor. The surgeon can then evaluate the uterus, ovaries, fallopian tubes, appendix, liver and gallbladder, helping him to diagnose and treat the cause of pain or infertility.

How is laparoscopy performed?

Starting a Laparoscopy

• A small incision is made just below the belly button.
• A thin needle is inserted into the abdomen; the abdominal cavity is inflated with carbon dioxide pumped in through the needle. This is done to create working space within the abdominal cavity, and to minimize the risk of injury to the internal organs as the laparoscope is inserted into the abdomen.
• The laparoscope is equipped with a camera which displays the images on a video monitor, giving the surgeon an excellent view of the pelvic structures.
• 1 or 2 additional incisions are made in the lower abdomen through which scissors or graspers are inserted to help the surgeon with the operation.

Diagnostic Laparoscopy

• The laparoscopy usually begins with inspection of the abdominal wall and the bladder to see if there are any adhesions (scar tissue) or endometriosis. The uterus is then carefully evaluated to make sure there are no abnormalities such as fibroids or congenital malformations.
• The ovaries and fallopian tubes are carefully evaluated for endometriosis, and scar tissue. The delicate tubal fimbriae, which trap the egg as it is released from the ovary, are carefully inspected to make sure there are no abnormalities.
• The lining of the abdomen behind the uterus, called the cul de sac, is a frequent site of endometriosis. The surgeon will also look at the appendix, liver and diaphragm to see if there is any abnormality.
• The final aspect of a diagnostic laparoscopy is the injection of blue dye into the uterus through the vagina. The blue dye then enters the tubes and should spill out from their end if there is no blockage.
• When the procedure is completed, the carbon dioxide gas is allowed to escape from the abdominal cavity and the instruments are removed
• The incisions are closed with absorbable stitches and covered with a band aid
• The skin incisions are injected with long acting local anesthetics for a more comfortable recovery from surgery.

Types of infertility surgery performed by laparoscopy

• Removal of uterine fibroids (myomectomy)
• Treatment of endometriosis
• Resection of pelvic adhesions (scar tissue)
• Surgery for blocked tubes
• Removal of ovarian cysts
• Treatment of tubal pregnancy
• Reversal of tubal ligation (tubal reanastomosis)

What are the risks of laparoscopy?

• All operations carry some risk. The risks associated with laparoscopy are low, and serious complications occur in less than 0.2% of cases
• With any general anesthesia there is a risk of reaction to medication
• Bleeding as a result of puncture of blood vessel
• Damage to nearby organs and tissues, such as the bowel or bladder
• Infection

Preparing for Laparoscopy

A preoperative appointment will be scheduled 1-2 weeks before your surgery. A physical exam will be performed and you will be asked to sign a consent form giving your doctor permission to perform the surgery.

Make sure you talk to your doctor about any concerns you may have, such as why is the surgery needed, what are its risks, how it will be done, and what the results will mean.

Tell your doctor if:

• You are or might be pregnant.
• You have allergies to any medicines.
• You had a problem with anesthesia.
• You are taking blood-thinning medicines, such as aspirin or warfarin (Coumadin).
• You have any bleeding problems.

Prior to the procedure:

• Do not eat or drink for at least 12 hours
• Leave your jewelry at home
• Remove your glasses, contacts, or dentures before the surgery
• Bring DVDs, books etc. – They are helpful during recovery.
• You can expect some abdominal discomfort after the procedure, so you may want to prepare several comfortable, loose fitting outfits to wear while recovering from the surgery.
• Wear low-heeled, comfortable shoes. You may be still groggy and unsteady from the anesthetics administered during surgery.
• Arrange for someone to drive you home after the laparoscopy.

What to Expect from Laparoscopic Surgery

At the hospital before the surgery:

• A nurse will insert an intravenous line or IV.
• The anesthesiologist will meet you and explain to you what to expect in the Operating Room.
• You will be given drugs and fluids through your IV to help relax you during the procedure.
• Your doctor will be available to answer any last-minute questions that you may have.
• Your family or friends may be able to stay with you until it is time for you to go to the operating room.

Once you are in the operating room:

• You will be brought into the operating room on a stretcher. The room is somewhat cold, and you will be covered with blankets to keep you comfortable.
• Once you are positioned on the operating room table, a belt will be placed around you to provide for your safety.
• An automatic blood pressure cuff will be placed on your arm, and a pulse oximeter, which measures the oxygen levels in your blood, will be taped to your finger. Special stockings will also be put on your legs to help keep your blood circulating and prevent blood clot formation.
• You will notice monitors, anesthesia equipment, lights above the operating table, and tables of sterile instruments.

Recovering from Laparoscopy:

• Right after surgery you will be taken on a stretcher bed to the Recovery Room. The nurses will care for you for about 2-4 hours until the anesthesia wears off and you are ready to go home
• The nurses will be giving you pain medication as needed to make you comfortable.
• When you are ready to go home you will be given care instructions and who to call if you have any problem.
• You will be given a post operative appointment to check your incisions and to review the operative findings
• You will experience some itching, pain and bruising around the incision for a few days after your surgery.
• Take pain medication and antibiotics as prescribed by your doctor.
• You may experience shoulder discomfort for 24-48 hours after the laparoscopy from the CO2 gas used during surgery to inflate your abdomen.
• You may shower the day after surgery but try to keep your incisions dry. If they get wet, pat them dry with a clean towel. Do not rub your incisions.
• You will be given a post operative appointment to check your incisions and to review the operative findings
• Laparoscopy typically takes between 2-7 days to recover from the surgery.
• Drink plenty of liquids after surgery and increase your diet slowly over the next 24-48 hours as tolerated.

When to Call Your Doctor 

Call your doctor immediately if you experience any of the following symptoms after a hysteroscopy:

• If you experience fever above 100.3 degrees.
• Excessive pain (not controlled by painkillers).
• Swelling or discharge from the wound.
• If you experience excessive bleeding.
• If you develop severe chest pain, experience persistent nausea and vomiting or shortness of breath.