What is a Laparoscopy?

Laparoscopy is a surgical procedure performed in order to examine the different organs inside the abdomen. It is performed in a minimally invasive way that requires only small incisions.  A laparoscope is a long, thin tube with a high intensity light and a high-resolution camera at the tip. The instrument is then inserted through an incision in the abdominal wall and sends high definition images to a video monitor.   Laparoscopy allows your doctor to see inside your body in real time.

Why is laparoscopy performed in gynaecology?

Laparoscopy is performed for the treatment of several gynecological conditions like:

• Endometriosis
• Ovarian cysts
• Growths on the womb
• Chronic pelvic pain
• Intestinal adhesions
• Ectopic pregnancies
• Infertility
• Abnormal uterine bleeding
• Utero-vaginal prolapse

Laparoscopy is usually performed under general anaesthesia.  This means that you will sleep through the procedure and won’t feel any pain.  The surgeon makes a 12 mm incision in the belly button and inserts the laparoscope through this incision.   Generally, between 1 – 4 incisions will be needed (ranging between 5 and 10 mm each).  These incisions allow other instruments to be inserted into the abdomen. The abdomen is then inflated with carbon dioxide gas, which allows the doctor to see the abdominal organs more clearly.  Even though, laparoscopic procedures are performed via minimal access incisions, it is not necessarily a small procedure and major surgery can be performed via this route. After the procedure the instruments are removed and the incisions are closed with stitches and surgical tape.

Why laparoscopy?

There are several advantages of laparoscopy over conventional open surgery (opening of the abdomen):

• Less risk for bleeding
• Less post-operative pain and analgesic use
• Shorter hospital stays
• Earlier mobilization with faster recovery
• Less wound infection
• Low risk of incisional herniation (wound herniation)
• Lower risk for post-operative thrombo-embolism

Most of these benefits can be attributed to more precise surgical technique, because of perfect illumination and magnification obtained by the laparoscope.  It is often referred to as placing the “surgeons’ eye” at the tip of the laparoscope. Unfortunately, laparoscopy is not without risk and as is the case with any other surgical procedure, there are small risk of bleeding, infection or injury to one of the organs.

Post-operative conduct

Post-operatively, the patient can often go home on the same day depending on the type of surgery performed.   It is also not uncommon to spend 1 – 2 nights in the hospital after the procedure.  After discharge, you will need a family member to drive you home. It is very common to have shoulder pain after the procedure.  This is usually the result of the carbon dioxide gas used to inflate the abdomen.  The gas often irritates the diaphragm which shares some nerve supply to the shoulder.  It may also cause some bloating, but luckily this often clears up within a day or two, especially when you start to mobilize freely.  You can usually resume all normal activities within 1 – 2 weeks.   The wounds need to be kept closed for 7 days after which it can be opened and kept open.   The surgical tape placed over the wounds, can be left in place until it dislodges spontaneously. Some doctors use external sutures, whereas others use internal dissolvable sutures.  In case of external sutures, these can be removed at our offices or at your local GP one week after the procedure.

Please notify us in case of any of the following:

• Progressive abdominal pain (the pain must improve on a daily basis)
• Fever
• Shortness of breath
• Sudden onset of swelling of one of the legs
• Red and tender wound site or draining of pus from any wound

A follow-up is usually scheduled 3 weeks after the procedure.   Make sure that you finalize this appointment with the office, even before your procedure.  Sick leave is usually granted for 1 – 2 weeks after the procedure, depending on the extent of the procedure.   In case of any emergency arising after hours, please go straight to Life St Georges hospital casualty department who will notify the Fembryo doctor on call.