What is a laparoscopy?
A laparoscopy is an operation used to look inside your abdomen. A thin instrument called a laparoscope (similar to a telescope) is inserted through a tiny cut in your belly button to help us examine and operate (if needed) in your abdomen without making large cuts. Laparoscopy is often performed as a day procedure – you don’t have to stay in the hospital overnight.
Why is a laparoscopy performed?
To diagnose certain problems it is necessary to look directly into the abdomen at the reproductive organs. Common reasons for undergoing a laparoscopy include the assessment of painful or heavy periods, pelvic pain (as may occur with endometriosis or adhesions), pelvic masses (such as ovarian cysts) or as assessment of fertility. You should have a clear understanding of your reason for this surgery – if you do not, please ask your doctor.
What are the alternatives?
Similar procedures may be performed by open surgery (laparotomy). This is a much more invasive procedure, involving a higher risk of complications, longer time in hospital and longer recovery after discharge. However, in certain situations a laparotomy may be the most appropriate procedure.
How is laparoscopy performed?
Laparoscopy is normally performed under a general anaesthetic in the operating theatre. You will be examined while you are asleep. Instruments may be inserted into the vagina or rectum to assist in the procedure. A small cut is made in your belly button. The abdomen is inflated with gas and a laparoscope is inserted to look at the internal organs. Further small cuts may be made in your abdomen if any abnormalities require treatment. After the procedure, the instruments are removed, the gas released and the cuts are then closed, with skin glue or with dissolving stitches. The procedure itself takes approximately thirty minutes or more, but you can expect to be in theatre and recovery for a number of hours.
What are the risks of undergoing this procedure?
You should be aware that every surgical procedure has some risk although the risks associated with laparoscopy are minimal.
There are some specific risks to be aware of in relation to this operation:
- The procedure may not be able to be completed laparoscopically, and you may require an “open” operation with a larger cut and an increased hospital stay.
- Deep bleeding may occur inside the abdomen. This may need fluid replacement, blood transfusion or further surgery. It may mean a longer stay in hospital and longer recovery time.
- Damage to other organs, such as bladder or bowel, which may need further surgery. This may mean a longer stay in hospital and longer recovery time.
- In rare cases the gas, which is passed into the abdomen, causes heart and chest complications.
- Infected fluid may collect in the abdominal cavity. This may need surgical drainage and antibiotics.
- Adhesions (bands of scar tissue) may form and cause bowel obstruction. This can be a short term or a long term complication and may need further surgery.
- In some people, healing of the wound may be abnormal and the wound can be thickened and red. The scar may be painful.
- A weakness in the wound may develop into a hernia. This may need further surgery.
- There is a possibility this procedure may not find the reason for the symptoms you have been experiencing.
There are some general risks inherent to all operations:
- Small areas of the lungs may collapse, increasing the risk of chest infection. This may need antibiotics and physiotherapy.
- Clots may form in the legs leading to pain and swelling. In rare cases part of this clot may break off and go to the lungs which can be fatal.
- You may suffer a heart attack or stroke because of strain on the heart. Death is an extremely rare possibility for anyone undergoing an operation.
Some women are at an increased risk of complications:
- Women who are very overweight have an increased risk of wound infection, chest infection, heart and lung complications and blood clots.
- Smokers have an increased risk of wound and chest infections, heart and lung complications and blood clots.
Preparation for your surgery
It is important that you have all the tests, which your doctor has ordered, prior to coming to hospital.
If you are taking any blood thinning or arthritis medications they may need to be stopped prior to surgery. Please check with your preadmission nurse or pharmacist.
It is necessary that you have nothing to eat or drink (including water, lollies and chewing gum) at least six hours before your operation. You should stop eating and drinking at the following times on the day of your surgery:
- at 12 midnight for a morning procedure
- at 6 am for an afternoon procedure
It is important for you to shower and dress into clean clothes prior to coming into hospital. No skin products are to be used following your shower (e.g. deodorant, perfume, body lotion, powder)
You need to bring with you:
- All X-rays, blood and ECG test results
- Any medications in their labelled containers or Webster pack
- your Medicare Card
- your completed registration form
- underwear, sanitary pads, toiletries
In some circumstances your surgery may need to be rescheduled or cancelled. If you are feeling unwell or have developed an illness we advise you to make an appointment with your GP who can then inform you if you are well enough to have surgery. If your surgery needs to be rescheduled or cancelled due to advice from a medical practitioner or due to unforseen personal circumstances please notify your gynaecologist as soon as possible.
What should I expect after the procedure?
You will stay in the recovery room within the theatre suite after the operation while you wake up from your anaesthetic. You will then be transferred in your bed to the Day Procedure Unit.
During your recovery your nurse will take frequent observations of your vital signs (eg temperature, pulse, blood pressure) for several hours after the surgery. As you become fully recovered, these become less frequent but remain regular until you leave hospital later the same day.
It is common to feel drowsy, have some abdominal discomfort or bloating, some mild nausea and experience pain on the tip of your shoulder (related to the gas used in the procedure). These symptoms can last from a few hours up to a few days following the operations.
You will be provided with pain relief as needed.
Your nurse will discuss your follow-up appointment and any discharge arrangements that have been made with you.
You should be eating and drinking normally, and be mobilising.
It is important that you stay in the company of a responsible adult within the Brisbane region for 24 hours and:
- do not drive or operate any heavy machinery
- do not consume alcohol for the remainder of the day
- do not drive a car, motorbike or ride a bicycle until you can comfortably operate foot pedals and / or change gears
- do not sign any legal documents or make any important decisions
- do not engage in sports or heavy lifting.
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 pelvic discomfort. You will be given specific discharge medication if required, but you may use Paracetamol/Paracetamol-codeine as required (one to two tablets every four hours up to a maximum of eight tablets per day)
It is important for you to shower rather than bath.
It is important for you to use sanitary pads and not tampons.
Wound care – rinse any wounds gently with water.
The sutures will be dissolvable and will not require removing.
What to avoid:
Intercourse, taking a bath, using tampons and swimming for two weeks.