What does laparoscopy mean?
An endoscopic diagnostic method that enables the inspection of the abdominal cavity to be performed with the use of a few mm- thin –tube (laparoscope), inserted through a small incision in the navel area.
This is a procedure that is usually performed by a gynecologist in order a number of diseases and disorders to be diagnosed and treated.
In the beginning of 20th century laparoscopy, as a method, was used only for treatment of abdominal disorders. The advancement, that this method features nowadays, provides opportunities to be performed sophisticated surgical interventions through a few small incisions rather than through larger incisions used in traditional surgery.
How is laparoscopy performed?
Laparoscopy is usually performed under general anaesthetic in the operating room.
Through a small incision (1 cm) in the patient’s navel area is inserted a thin tube, on the top of which is installed a small camera.
In order the inside organs to be seen, gas (carbon dioxide) is used and thus the abdominal cavity is expanded. The attached camera allows the gynecologist to watch his/her actions on a video screen.
Via laparoscopy can be performed a precise inspection of the liver, appendix, the surface of the intestine, bladder, ureter and internal genital organs of the patient.
In particular, the gynecologist is able to see the patient’s uterus, ovaries, uterine tubes, colon and upper part of the uterine cervix. This technique allows the physician to diagnose a wide variety of diseases.
If surgery treatment is necessary, one or a few small (only 5 mm) cuts can be made. Through these cuts with the use of long instruments (sterile plastic bags, expansion tools and lasers), depending on the patient’s condition, the tissue inside the abdomen can be cut, clamped, removed or burned.
The gynecologist operates by moving the instruments via 'hand-eye coordination”, watching the video monitor. This type of surgery requires solid practical experience because the tissues are touched only remotely via fine long tools and the doctor’s movements have to be very precise.
Gynecologists use laparoscopy to treat wide range of female medical disorders.
Indications for laparoscopy in gynecological treatment:
- Pelvic pain
- Tubal ligation (tubes tied)
- Tubal (ectopic) pregnancy
- Pelvic inflammation
- Plastic surgery of the fallopian (uterine) tubes
- Removal of adhesions caused by previous operations or disorders
- Assisted vaginal hysterectomy
- Removal of ovary cysts or the entire ovary
- Inspection and removal of pelvic lymph nodes
- Diagnosis and surgical treatment of some uterine anomalies, destruction or removal of uterine carcinoma (myoma).
Deciding on laparoscopy
- The decision whether a laparoscopy should be applied (versus the use of non-surgical treatment or surgery with a larger cut) implies a very individual approach and requires a detailed consultation between the patient and the physician.
- Physicians have to be aware that sometimes patients’ perception of the surgical procedures may be quite different from their own. This requires clarification and assessment of risks and benefits. Furthermore, patients should be aware that some complications may occur during the surgical procedures. From this perspective, when such a surgical intervention is performed, there should always be a balance between the expected benefits and potential risks of possible complications.
Although complications do not occur frequently, yet, laparoscopy is a surgical manipulation.
All surgical procedures carry the risk of potential complications.
Some possible complications that may occur during a laparoscopic surgery, such as injury to the intestines, blood vessels affection (vessels hidden under the abdominal skin surface), bladder damage or the urethra, damage or scratching of the internal genitals, require additional surgical procedures so that the affected areas to be restored.
The complexity of the surgical procedures or the difficulties of dealing with the complications that may have occurred at the time of the laparoscopic surgery, may require the performance of a more complex operation (through a larger cut), called laparotomy.
Each patient’s treatment involves a very individual approach! Before being discharged, the patient has to be at ease and calm. This condition is obtained when the patient has the support of the nurses and her physician and the medical advice provided by them.
In case that after the laparoscopic procedure you have some of the following symptoms, contact immediately your physician.
- Expanding bruise below the cut ( this may be a result from a blood clot (coagulum) or some bleeding under the skin),
- vomiting, fever or abdominal bloating,
- excessive vaginal bleeding ( spotting occurs frequently and is usually harmless),
- increasing pain, despite the painkillers and an acute, strong flank (kidney) pain that may be due to the entanglement of or injury to one of the ureters.
Therefore, it is required the patient to stay overnight in the hospital under strict medical observation and care.
After the laparoscopy
After the laparoscopy procedure and the minimum hospital stay required, most patients leave the hospital and go home with a prescription for pain medication and advice to avoid stress for about a week.
Each patient has a different recovery period. Many women complain of shoulder pain, caused by the gas used for the abdominal expansion. Some women notice pain at the area of the cuts, while others feel sharp or dull pain, and persistent pain deep in the pelvis due to the stimulation of the tissues that have been manipulated or cut during surgery. All of these symptoms are typical and can be easily alleviated with appropriate painkillers, heated pillow and sufficient rest.
Most obstetricians advise their patients to avoid driving, exercise, sex and heavy lifting for 1-2 weeks.
Let's talk before we decide...
As usual, the treatment requires individual approach and is rarely absolutely clear. An important part of the patient’s informed consent is the discussion between the patient (and her family if the woman wishes) and her physician about the risks and benefits for each of the planned procedures.
In conclusion, the laparoscopy is a very good method for performing gynecological surgery. Despite the tricky nature of the operation, most women recover very quickly after it.
What is necessary in each particular case, is a detailed consultation with an experienced gynecologist, who will help the patient to assess the advantages and disadvantages of the laparoscopy compared to other alternative methods, and to determine whether it is advisable or not to diagnose or treat the disease.