Laparoscopy
A laparoscopy is a surgical procedure which is used in order to look inside the abdomen and pelvis, by inserting a thin telescope with a light source attached, called a laparoscope.
How is a laparoscopy carried out?
A laparoscopy, also referred to as keyhole surgery or minimally invasive surgery, involves making between one and four small incisions in the skin and then passing through a thin, flexible tube with a telescope, light and camera attached (laparoscope) and a tube used to pump gas into the body so that there is more room to look around.
The images captured are relayed on a television screen, allowing a surgeon to see inside the abdomen for medical examination or treatment. Following the procedure, the gas will be released from the body and the cuts will be closed up with stitches and a dressing.
The procedure is carried out under general anaesthetic, meaning the patient will not be able to feel pain while the surgery is taking place. Most people will be able to go home on the same day, though some might have to stay at the ward overnight.
A laparoscopy is carried out to either find the cause of symptoms in order to diagnose a medical condition or to carry out a surgical procedure to provide treatment. If being used to diagnose, it can take between 30-60 minutes, whereas for treatment the procedure time will vary.
When is a laparoscopy necessary?
Keyhole surgery is used to help diagnose many conditions which develop inside the abdomen or the pelvis, principally those which cannot be diagnosed through other, non-invasive methods, like an ultrasound, CT scan or MRI scan.
Laparoscopic surgery is also an important surgical procedure used to remove tissue which needs to undergo further tests (known as a biopsy), or to remove an injured or diseased internal organ.
The three most common medical areas in which a laparoscopy is carried out are:
- Gynaecology – the treatment of conditions which specifically affect the female reproductive systems
- Urology – the treatment of conditions which affect the urinary system
- Gastroenterology – the treatment of conditions which affect the digestive system
Focusing on gynaecology, there are several conditions which are diagnosed and treated via laparoscopic surgery, including:
- Endometriosis – which is where tissue lining the womb grows outside of the uterus in abnormal places, causing intense pain. A laparoscopy is used to confirm endometriosis diagnosis and to treat severe cases by removing or destroying the endometrial tissue.
- Ovarian Cysts – which are fluid-filled sacs forming on the ovaries. They are very common and do not normally require medical attention, except in certain cases, in which case a laparoscopy may be necessary to remove the cysts.
- Fibroids – tumours that are non-cancerous and grow in or around the uterus. A laparoscopic myomectomy can be carried out to remove fibroids, while keeping the uterus in place.
- Ectopic pregnancy – which is a pregnancy that has developed outside of the womb. A laparoscopy can remove the ectopic or the fallopian tube.
- Pelvic Inflammatory Disease (PID) – which is a bacterial infection of the female reproductive organs, usually caused by a common, untreated sexually transmitted infection.
- Infertility in women
- Hysterectomy – removing the womb and/or cervix in order to treat PID, endometriosis, or heavy, painful periods.
- Removing a pelvic abscess
- Diagnosis of certain types of cancer, including ovarian cancer
Laparoscopic surgery is not suitable for all patients and there are certain cases where you might be offered an alternative, particularly if you are severely overweight, have been through the menopause, have already had abdominal surgery or have a lung or heart condition.
One alternative is a laparotomy, which is a more invasive procedure that involves making a large cut in the abdomen and performing an open surgery. This might be necessary where a patient requires immediate treatment or where a serious surgery is needed, for example, a hysterectomy.
Your surgeon will discuss with you the best option based on your individual needs and will outline the risks and benefits of each type of surgery.
Who carries out a laparoscopy?
Most gynaecologists can perform laparoscopic surgery, but complex and challenging procedures require advanced skills, which can only be gained through training, experience and keeping up to date with modern advances in the field.
At the London Women’s Centre, we offer cutting-edge treatments at the highest standard carried out by gynaecologists with the training and skills necessary to carry out these procedures. Our main goal is to achieve the best outcome and ensure the patients’ safety.
Preparing for a laparoscopy
Patients will normally be advised not to eat or drink anything for 6-12 hours before the procedure, but this will depend upon what type of laparoscopic surgery they are undergoing.
You will be advised to stop taking blood-thinners (anticoagulants), such as Aspirin or Warfarin, since these may cause excessive bleeding. You should also stop smoking as this slows down the healing process and can cause further complications.
Post-surgery
You will awake from the general anaesthetic feeling somewhat disoriented and bleary. Some may vomit, but this is normal and should not be worried about just yet.
Be sure to arrange for a family member or friend to pick you up from the hospital after your surgery, as you will not be safe to drive yourself home, or for at least 24 hours after.
It is also strongly recommended that you have someone close to you take care of you for the first 24 hours after the procedure. This is as a matter of safety, in case you were to experience any symptoms which would require emergency medical attention, such as high temperatures, severe vomiting, infection around the wounds or pain and swelling in the legs.
The medical staff will tell you how to wash and dress your wounds and you’ll be required to book a follow-up appointment, which must be attended so that the doctor can check that you are healing well and to remove stitches if necessary (some are dissolvable).
It is normal to feel some discomfort and pain for several days following the procedure and you should be prescribed painkillers to help ease this. Moreover, you may feel the effects of the gas left over in your abdomen, which can result in cramps, bloating or shoulder pain – this is all normal and should pass after a few days.
Recovering from laparoscopy will vary from patient to patient and will depend upon the type of surgery you have undergone. Factors affecting recovery times include the reason for the surgery, your own health, whether you have followed post-surgery advice properly and whether any complications have arisen.
You should seek advice from the surgeon about likely recovery times and when you are able to return to normal activities.
What are the benefits of a laparoscopy?
As laparoscopic surgery is minimally invasive, there are several benefits to this type of procedure over other, more invasive methods. These include:
- A shorter stay in the hospital, with most patients being able to leave on the same day
- Quicker recovery times and return to normal activities
- Less pain and discomfort following the operation
- Reduction risk of bleeding
- Reduced risk of infection
- Reduced risk of adhesions
- Reduced risk of a blood clot in the legs or lungs
Moreover, the need for only a small number of incisions means there is less scarring than more invasive methods, achieving a better cosmetic outcome for the patient.
The surgeon performing the procedure is also able to better visualise and access the area for diagnosis or treatment. If a condition is found, the surgeon might also be able to treat it during the same operation.
What risks are involved?
As with every operative procedure, undergoing a laparoscopy carries some risks, however, the procedure is widely performed and the risks are relatively low.
Minor complications may occur in around 1 or 2 in 100 cases. These include infection, minor bleeding and bruising around the cuts and feeling nauseous.
Serious complications are rare but will be discussed with you before surgery.