Laparoscopy is a surgical procedure that has been used widely in medicine over 30 years.faster recovery time, the minimizing of pain, hospitalization and better aesthetic result are some of the advantages which made laparoscopy very popular among patients and surgeons. Also, some technical parameters such as the magnification offered by the endoscope during the procedure and the small risk of complications resulted in the wide use of laparoscopic surgery in gynecology. Laparoscopy has gained a leading role and appears to be the gold standard method for a quiet wide range of gynecologic procedures such as tubal ligation, removal of ovarian cyst or adnexa, treatment of ectopic pregnancy, hemorrhagic rupture of a cyst, exploration of chronic pelvic pain, sterility, treatment of endometriosis, removal of fibromyomata , hysterectomy, and lately for treatment of pelvic organ prolapses, urinary incontinence and even in gynecologic cancers.
What is a laparoscopy?
As a diagnostic procedure, a laparoscopy is done to find out the cause of pelvic pain, fertility problems, or gynecological) symptoms that cannot be confirmed by a physical examination or ultrasound. For example, a laparoscopic examination can identify ovarian cysts, endometriosis, adhesions (scarring), ectopic pregnancy or blocked fallopian tubes. It is carried out as a day- case procedure. Laparoscopy can also be used to examine the appendix, bowel, gallbladder, or liver.
As an operative procedure, laparoscopy is used for female sterilization, treating an ectopic pregnancy, treating endometriosis and/or adhesions, removal of ovarian cysts or abnormal ovaries, and opening or removing damaged tubes. Most of the fibroids in the uterus can be removed by laparoscopy. Laparoscopy can also be used to perform a hysterectomy.
While many of these procedures can be carried out using regular open surgery, laparoscopy usually involves:
Because laparoscopy is so much less invasive than traditional abdominal surgery, patients can leave the hospital sooner, usually within 12 – 24 hours.
Some common reasons for having a Diagnostic Laparoscopy
Infertility : A laparoscopy can determine if there is any abnormal anatomy, endometriosis, blocked fallopian tubes, or some other reason for infertility. A dye may be injected through the neck of the womb via the vagina to see if the fallopian tubes are open. If the tubes are open, the dye will be seen spilling out of the ends.
Pelvic pain : There are many possible causes of pelvic pain that can be diagnosed with laparoscopy. These include endometriosis, adhesions (scar tissue), ovarian cysts, ectopic pregnancy, pelvic inflammatory disease (PID), and abnormalities of the uterus.
Sterilization :In this operation the fallopian tubes are sealed with a clip to reduce the risk of pregnancy.
Ectopic pregnancy : If a fertilized egg becomes embedded outside the uterus, usually in the fallopian tube, an operation can be performed to remove the developing embryo. This is preferably done with laparoscopy. Usually the affected tube is removed, though sometimes an attempt can be made to remove the pregnancy whilst leaving the tube in place.
Endometriosis : This is a condition in which tissue from inside the uterus is found outside the uterus in other parts of (or on organs within) the pelvic cavity. This can cause cysts to form in an ovary. Endometriosis is diagnosed with laparoscopy, and in some cases the cysts and other tissue can be removed during the procedure.
Ovarian cysts : Cysts in the ovaries can be removed using laparoscopy, or the whole ovary can be removed.
Adhesiolysis : Adhesions (scarring) between organs within the abdomen or pelvis can be associated with pain and/or infertility. The adhesions may result from previous surgery, infections, or endometriosis. Cutting these adhesions, known as adhesiolysis, may improve symptoms.
Fibroids : Fibroids in the uterus can be successfully removed using laparoscopy. The fibroid is ‘shelled-out’ from the lining of the uterus and then a special instrument (morcellator) is used to cut the fibroid into pieces for removal. The defect in the uterine wall is then stitched using laparoscopy.
Hysterectomy : This procedure to remove the uterus can be performed using laparoscopy. The uterus is cut away with the aid of the laparoscopic instruments and then the uterus is removed either through the vagina or through the laparoscopic keyholes in case of very large uterine size.
What happens during a laparoscopy?
Laparoscopy is a surgical procedure performed in the hospital under general anaesthesia. Before starting the procedure, the bladder is emptied with a small catheter and the skin of the abdomen is cleaned.
After you are anaesthetized, a hollow needle is inserted into the abdomen through a small cut through or just above the navel (tummy button), and carbon dioxide gas is pumped through the needle to expand the abdomen. This allows the surgeon to get a better view of the internal organs. The laparoscope is then inserted through this cut to look at the internal organs on the video monitor.
Usually one or two additional small cuts are made along the ‘bikini line’ to insert other instruments which are used to lift the tubes and ovaries for examination or to perform surgical procedures.
Preparation for the procedure
You should not eat or drink for about 6 hours before the procedure.Doctor may prescribe some medications on the previous night to swallow and to put in the vagina, so as to ascertain an empty bowel and clean aseptic lower genital tract, during the surgery. An enema may be given 2 hours prior to the procedure.
Nurses will check your vital signs (blood pressure, pulse, temperature and rate of breathing) after the operation. If there are no complications, you may leave the hospital within four to six hours of a diagnostic procedure. If you have had an operative laparoscopic procedure, you may need to stay in hospital for one night or so. (Traditional abdominal surgery requires a hospital stay of four days or more.) There may be a some slight pain or throbbing in the first day or two after the procedure at the sites where the cuts were made. The gas that is used to expand the abdomen may cause discomfort under the ribs or in the shoulders for a few days. Depending on the reason for the laparoscopy in operative procedures, some women may experience vaginal bleeding. Many patients can return to work within a week of surgery and most are back to work within two weeks.