Dr Karuna Raja

Laparoscopic Surgery

Information on Laparoscopy and Laparoscopic
(key-hole) Surgery

A laparoscope is a long and narrow surgical telescope which is inserted in the  abdomen through a small incision in the belly button.  The abdomen is distended with a gas called carbon dioxide to allow us to see the pelvic organs and to use other instruments for surgery under direct vision.  Small second, third and fourth cuts may also be made in the lower abdomen for scissors, coagulator, or laser to preform major closed surgery at laparoscopy.  This surgery is preformed under general anaesthesia.  Videos and pictures may be taken during surgery, these are used to show you the type of surgery preformed as well as for teaching purposes.  You may be given antibiotics at any time of the surgery.

Laparoscopy is usually a day only procedure and operating time ranges from 1-4 hours, occasionally longer.  Occassionally  patients may need admission to the hospital for overnight stay particularly if surgery was long and complicated or if you have significant nausea, drowsiness or pain.  A hysteroscopy (the use of a small telescope through the vagina into the uterus to visualise the uterine cavity), dilatation and curettage may also be preformed if indicated at the time of  laparoscopy.

 

Risks and Complications

Complications from laparoscopic surgery are uncommon, but do occur in 2 per 1000 cases.  Due to the complications, or finding of life-threatening abnormalities, immediate open abdominal surgery may be necessary.  Probability of severe complications such as hysterectomy (removal of uterus), colostomy (bowel bag), paralysis, or death is rare.  The operation, is for example safer than driving a car or being pregnant.  The complication rate increases if you have had previous surgery or abdominal/pelvic infection.

Less serious complications include:

  • Bleeding (leading to blood transfusion)
  • Infection (particularly of the belly button and other skin cuts)
  • Injury to the stomach or intestines
  • Abnormal gas collections underneath the skin and in the chest (called surgical emphysema)
  • Damage to ureter (tube carrying urine from the kidney to the bladder) and urinary system
  • Blood blots in the pelvis and lungs
  • Conversion to open surgery (either due to complications or technical difficulty in continuing with laparoscopy)
  • Allergy and other reactions to one or more substances used in the procedure
  • Complications can also arise due to your positioning on the operating table (i.e. nerve injury)
  • 3-8 in every 100,000 women undergoing laparoscopy die as a result of complications.

In some cases, the alternative procedure to laparoscopic surgery is open surgery.  However, this may carry the same risks and a much longer period to recover with pain and discomfort.  In those patients in whom laparoscopic surgery is possible, it provides early recovery and less discomfort.

 

Pre-Operative Preparations

  • No aspirin or related drugs for 10 days. Please discuss with me if you are unsure about your medication
  • Stop the oral contraceptive pill 10 days before, but use alternative contraception (you have to be absolutely sure that you are not pregnant at the time of procedure).
  • Stop smoking. Smoking increases surgical risk and should be stopped as soon as a decision to go ahead with surgery is made.
  • Bowel preparation (special diet and fasting). This sometimes may have to be started upto 48 hours before surgery (a separate information sheet on this topic will be provided).

 

What to expect after surgery (Post-Operative Period)

Although all attempts are made to expel the carbon dioxide gas after surgery, shoulder pain is common due to collection of gas under the rib cage, if this occurs you should take pain killers.  Heat packs placed around the shoulder will give symptomatic improvement.  Try to find a sitting position which gives you the most comfort.  To reduce abdominal pain try to support your abdomen with a pillow on movement, laughing or sneezing.

Your throat may be sore due to irritation caused by the endo-tracheal tube (used to anaesthetize you).  To relieve this, you can take soothing lozenges or fluids.  you may have some vaginal bleeding or discharge that may continue for 1-2 weeks after surgery.  This should not be heavy.  Avoid intercourse or the use of tampons till the bleeding is stopped.

A small dressing is applied to the abdominal wounds which should be removed (by you) 3-4 days after the surgery.  There may be some blood stained discharge from the wounds initially.  Keep the wound dry by pat drying after a shower or using a hair dryer at a low setting (not too warm).  You may initially have some difficulty in passing urine or opening your bowels.  Plan to avoid any activities that will require concentration (including driving) for at least two days.  you can usually return to work and moderate activities in 2-3 days, however, the recovery time varies according to the extent of surgery.  You may need 1-3 weeks to return to heavy activities and for full recovery.  You should feel better each day after your surgery.  If you are worried, ring your GP or me for advice or any questions you have.  You should be concerned if you have increased abdominal pain, fever, significant bleeding or severe nausea and vomiting.

 

Common indications for laparoscopic surgery include:

  • To perform tubal sterilization (tube tying for contraception)
  • Ectopic pregnancy
  • Investigation of infertility/abdominal, pelvic pain
  • Endometriosis
  • Some uterine fibroids
  • Ovarian cysts/pelvic masses
  • Some types of hysterectomies

 

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