Laparoscopy

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 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.

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.

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.