Laparoscopy - gynaecological

About gynaecological laparoscopy

Gynaecological laparoscopy can be used to:

  • diagnose and treat endometriosis
  • diagnose and treat pelvic inflammatory disease
  • remove scar tissue (adhesions)
  • treat an ectopic pregnancy
  • carry out female sterilisation, which is permanent contraception
  • remove an ovarian cyst
  • remove your womb (hysterectomy) or ovaries (oophorectomy)
  • treat fibroids
  • remove lymph nodes for cancer treatment

Your surgeon may also suggest a laparoscopy if you have pain in your abdomen because it may help to find out the cause. If you're having problems getting pregnant, you can have a laparoscopy to see if there are any problems with your ovaries, fallopian tubes or womb.

What are the alternatives?

Gynaecological laparoscopy isn’t suitable for everyone. Depending on your symptoms and circumstances, there may be other investigations or treatments available.

Ultrasound can also be used to diagnose some gynaecological conditions such as fibroids. This investigation uses sound waves to produce an image of the inside of part of your body. There are two types of ultrasound that can be used to diagnose a gynaecological problem. Abdominal ultrasound is when the ultrasound probe is moved over your abdomen. A trans-vaginal ultrasound is where the ultrasound probe is put into your vagina.

You may be able to have a CT or MRI scan to investigate symptoms that suggest you have fibroids or endometriosis.

If you need to have a treatment, you may be offered medicines or further surgery. For example, your surgeon may need to make a large cut in your lower abdomen (abdominal hysterectomy) or the top of your vagina (vaginal hysterectomy).

Your surgeon will explain the different procedures and discuss which option is best for you.

Preparing for a gynaecological laparoscopy

Your surgeon will explain how to prepare for your procedure. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest infection or wound infection and slows your recovery.

If you're having a gynaecological laparoscopy to diagnose a condition, you will usually have it done as a day-case procedure. This means you have the procedure and go home the same day. If you have a gynaecological laparoscopy to treat a condition, you may need to stay in hospital overnight.

A gynaecological laparoscopy is usually done under general anaesthesia, which means you will be asleep during the procedure. You will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your gynaecologist's advice.

At the hospital, your nurse may do some tests such as checking your heart rate and blood pressure, and testing your urine.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. Also, you may need to have an injection of an anticlotting medicine as well as, or instead of, wearing compression stockings.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during a gynaecological laparoscopy?

The procedure can take 15 minutes or more depending on what type of examination or treatment you need.

Your surgeon will make a cut in your belly button. He or she will then put a tube through the cut and pump some gas in. This expands your abdomen, separates your organs and makes it easier for your surgeon to look at your organs with the laparoscope. If you need any treatment, or if your surgeon needs to move some of your organs to get a good view, he or she will make some small cuts lower down on your abdomen. Any surgical instruments that are needed for treatment can be inserted through these cuts. Your surgeon may inject a coloured dye through your cervix (neck of your womb), into your womb and your fallopian tubes. This can show whether your fallopian tubes are blocked.

At the end of the procedure, your surgeon will carefully take the instruments out of your abdomen and allow the gas to escape through the laparoscope. He or she will close the cuts with stitches.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed and may need pain relief to help with any discomfort. General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon’s advice.

You will usually be able to go when you feel ready, but will need to arrange for someone to take you home. Try to have a friend or relative stay with you for the first 24 hours after your laparoscopy. Your nurse will give you some advice about caring for your wounds, hygiene and bathing and you may be given a date for a follow-up appointment.

Your surgeon may use dissolvable stitches. The length of time your dissolvable stitches will take to disappear depends on what type of procedure you had. However, as a general guide, they should usually disappear in seven days. If you have non-dissolvable stitches you will need to have them taken out. Your surgeon will tell you when and where to have them removed.

Recovering from a gynaecological laparoscopy

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

If you have a laparoscopy to diagnose a condition you will need to rest and take it easy for up to one week, though this will depend on the type of procedure you had. If you have treatment during the laparoscopy – for example for endometriosis or a hysterectomy – your recovery will take longer.

Follow your surgeon’s advice about contraception and when you can have sex again.

What are the risks?

As with every procedure, there are some risks associated with gynaecological laparoscopy. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. For example, you're likely to feel some pain in your abdomen and you may also have pain in your shoulders. This is caused by the gas used to inflate your abdomen; it usually improves within 48 hours.

You may have some bruising on your abdomen around the areas where the laparoscope and any surgical instruments were put in – this usually gets better without treatment.

Complications

This is when problems occur during or after the procedure. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in your leg (deep vein thrombosis, DVT).

Other complications of having a gynaecological laparoscopy are listed below.

  • Other organs in your abdomen, such as your bowel, bladder, womb or major blood vessels, may be damaged during the operation.
  • During your laparoscopy, your surgeon may need to change to open surgery, which involves him or her making a bigger cut on your abdomen. This is done if it's impossible to complete the procedure safely using the laparoscope, or if there is a complication during laparoscopy that requires a larger cut to be made on your abdomen.
  • Your wounds may not heal properly or they may become infected.
  • You may develop a urine infection.
  • You may develop a hernia.

Most women don’t have any problems after a gynaecological laparoscopy. However, if you develop any of the following symptoms, contact your doctor.

  • Severe pain or pain that gets worse.
  • A swollen abdomen.
  • A high temperature.
  • Red skin around your wound or any discharge.

Speak to your surgeon for more information.

What is the difference between a laparotomy and a gynaecological laparoscopy?

Answer

Laparotomy is a procedure that involves making a large cut to your abdomen (tummy). A gynaecological laparoscopy is a procedure that involves making several (two to four) small cuts on your abdomen.

Explanation

A laparotomy is an operation where a large cut is made in your abdomen. A cut can be made from under your rib cage down to your bikini line, or across your abdomen. You may have a laparotomy if your surgery can't be done safely using a laparoscopy.

During a gynaecological laparoscopy, your surgeon will make small cuts in your abdomen so that he or she can use a telescope with an attached camera and insert any surgical instruments that are needed.

There are some advantages to having a gynaecological laparoscopy instead of a laparotomy – the main ones are listed below.

  • You're likely to have less pain because the cuts are smaller and there is less pulling or stretching of the muscle and skin of your abdomen.
  • You're likely to be in hospital for a shorter time.
  • Your recovery period is shorter, and therefore causes less disruption to your family life and work.
  • Your scars are smaller. As well as looking better, this also means there is less risk of an infection or of the wound not healing.

Laparoscopy isn't suitable for everyone and may not be the best option for some types of surgery. Your surgeon will discuss your treatment options with you.

I’m going to have a gynaecological laparoscopy and dye test. What does this involve?

Answer

If you're having investigations for infertility, your doctor may ask you to have a gynaecological laparoscopy and dye test. The dye test is used to check whether or not your fallopian tubes are blocked.

Explanation

Normally an egg travels down the fallopian tubes from your ovaries, to your womb. If you have unprotected sex, sperm can swim up the fallopian tube and fertilise the egg, resulting in pregnancy. If your fallopian tubes are blocked, the egg and sperm can't meet.

If you're having problems getting pregnant, your doctor may suggest you have a laparoscopy and dye procedure. During this procedure, your surgeon can see whether there are any obvious reasons why you might not be able to get pregnant, such as endometriosis. At the same time, he or she may also do a hysteroscopy. This is a procedure that allows your surgeon to look inside your womb using a narrow tube-like telescopic camera called a hysteroscope.

During the laparoscopy, a harmless, blue dye is injected through your cervix (neck of the womb) and into your womb and fallopian tubes. The dye will run through your womb and fallopian tubes and will come out of the end of the tubes if they are normal.

After the procedure, you may have a dark vaginal discharge for a day or two. Your surgeon will explain what to expect and how to look after yourself following the procedure.

I’m having a gynaecological laparoscopy for sterilisation. What does this involve?

Answer

Sterilisation is a permanent form of contraception. During the procedure your surgeon will block your fallopian tubes using clips or rings, so that your egg and sperm can't meet.

Explanation

Sterilisation is usually done as a day-case procedure. This means you have the operation and go home the same day. Sterilisation is usually done using a laparoscopy under general anaesthesia, which means you will be asleep during the procedure.

Your surgeon will make two small cuts, one just below your belly button and the other just above your bikini line. He or she will put a laparoscope into your abdomen through one of the cuts. On the laparoscope is a camera that allows your surgeon to see your fallopian tubes. He or she will seal or block the tubes with clips or rings.

Speak to your surgeon for more information.