Laparoscopic Pelvic Surgery
What is laparoscopy?
Laparoscopy is a type of surgery. In “open” surgery, an incision is made in the skin. This means making an incision that can be several inches long in the abdomen. Laparoscopy is a way of doing surgery using small incisions (usually no more than 1/2 inch long). Laparoscopic surgery sometimes is called “minimally invasive surgery.”
How is laparoscopic surgery done?
Laparoscopic surgery uses a special instrument called the laparoscope. The laparoscope is a long, slender device that is inserted into the abdomen through a small incision. It has a camera attached to it that allows the obstetrician–gynecologist (ob-gyn) to view the abdominal and pelvic organs on an electronic screen. If a problem needs to be fixed, other instruments can be used. These instruments usually are inserted through additional small incisions in the abdomen. They sometimes can be inserted through the same single incision made for the laparoscope. This type of laparoscopy is called “single-site” laparoscopy.
What are the benefits of laparoscopy?
Laparoscopy has many benefits. There is less pain after laparoscopic surgery than after open abdominal surgery, which involves larger incisions, longer hospital stays, and longer recovery times. Recovery from laparoscopic surgery generally is faster than recovery from open abdominal surgery. The smaller incisions that are used allow you to heal faster and have smaller scars. The risk of infection also is lower than with open surgery.
What are the risks associated with laparoscopy?
Laparoscopy can take longer to perform than open surgery. The longer time under anesthesia may increase the risk of complications. Sometimes complications do not appear right away but occur a few days to a few weeks after surgery. Problems that can occur with laparoscopy include the following:
- Bleeding or a hernia (a bulge caused by poor healing) at the incision sites
- Internal bleeding
- Damage to a blood vessel or other organ, such as the stomach, bowel, bladder, or ureters
For what surgical procedures can laparoscopy be used?
Tubal sterilization can be done using laparoscopy. Laparoscopy also is one of the ways that hysterectomy can be performed. In a laparoscopic hysterectomy, the uterus is detached from inside the body. It can be removed in pieces through small incisions in the abdomen or removed in one piece through the vagina.
What problems can laparoscopy be used to diagnose and treat?
Laparoscopy may be used to look for the cause of chronic pelvic pain, infertility, or a pelvic mass. If a problem is found, it often can be treated during the same surgery. Laparoscopy also is used to diagnose and treat the following medical conditions:
- Endometriosis—If you have signs and symptoms of endometriosis and medications have not helped, a laparoscopy may be recommended. The laparoscope is used to see inside your pelvis. If endometriosis tissue is found, it often can be removed during the same procedure.
- Fibroids—Fibroids are growths that form inside the wall of the uterus or outside the uterus. Most fibroids are benign(not cancer), but a very small number are malignant (cancer). Fibroids can cause pain or heavy bleeding. Laparoscopy sometimes can be used to remove them.
- Ovarian cyst—Some women have cysts that develop on the ovaries. The cysts often go away without treatment. But if they do not, your ob-gyn may suggest that they be removed with laparoscopy.
- Ectopic pregnancy—Laparoscopy may be done to remove an ectopic pregnancy.
- Pelvic floor disorders—Laparoscopic surgery can be used to treat urinary incontinence and pelvic organ prolapse.
- Cancer—Some types of cancer can be removed using laparoscopy.
Laparoscopy usually is performed with general anesthesia. This type of anesthesia puts you to sleep. Regional anesthesia is used instead of general anesthesia in some situations. This type of anesthesia blocks feeling in a region of your body—such as the area below your waist—so that no pain is felt.
What happens during the procedure?
After you are given anesthesia, a small incision is made in or below your navel or in another area of your abdomen. The laparoscope is inserted through this small incision. During the procedure, the abdomen is filled with a gas. Filling the abdomen with gas allows the pelvic reproductive organs to be seen more clearly. The camera attached to the laparoscope shows the pelvic organs on a screen. Other small incisions may be made in the abdomen for surgical instruments. Another instrument, called a uterine manipulator, may be inserted through the vagina and cervix and into the uterus. This instrument is used to move the pelvic organs into view.
What happens after the procedure?
After the procedure, the instruments and most of the gas are removed. The small incisions are closed. You will be moved to the recovery room. You will feel sleepy for a few hours. You may have some nausea from the anesthesia. If you had outpatient surgery, you will need to stay in the recovery room until you can stand up without help and empty your bladder. You must have someone drive you home. You usually can go home the same day. More complex procedures, such as laparoscopic hysterectomy, may require an overnight stay in the hospital.
What should I expect during recovery?
For a few days after the procedure, you may feel tired and have some discomfort. You may be sore around the incisions made in your abdomen and navel. The tube put in your throat to help you breathe during the surgery may give you a sore throat. Try throat lozenges or gargle with warm salt water. You may feel pain in your shoulder or back. This pain is from the small amount of gas used during the procedure that remains in your abdomen. It goes away on its own within a few hours or days. If pain and nausea do not go away after a few days or become worse, you should contact your ob-gyn.
How soon after laparoscopy can I resume my regular activities?
Your ob-gyn will let you know when you can get back to your normal activities. For minor procedures, it is often 1–2 days after the surgery. For more complex procedures, such as hysterectomy, it can take longer. You may be told to avoid heavy activity or exercise.
What signs or symptoms should I watch out for after laparoscopy?
- Pain that is severe or gets worse
- Heavy vaginal bleeding
- Redness, swelling, or discharge from the incision
- Inability to empty your bladder