Introduction

Everything you need to know

What is laparoscopy?

Laparoscopy is a form of minimally invasive key-hole surgery used to inspect and operate on the organs within the abdomen (Tummy) and pelvic area without making large incisions (cuts). This is usually performed under general anesthesia. Laparoscopic surgery can be used either for diagnostic or therapeutic purposes or both.

Preparations

  1. First gynecologist should decide whether you need a laparoscopic surgery. (After considering your history, examination, and investigation)
  2. Then you will receive a date for the surgery.
  3. You should admit to the ward a day prior to the surgery.
  4. After explaining the indication, procedure, complications of the laparoscopic surgery, an informed written consent will be taken.
  5. Please shower in the evening before surgery or in the morning of the relevant day.
  6. Please do not shave the surgical site. If necessary it will be done for you.
  7. After you admit to the ward, the hospital staff will take blood for cross-matching if needed and other basic blood investigations  & other investigations like ECG that decide whether you are fit enough to undergo surgery under general anesthesia.
  8. Premedication also will be provided by the ward staff.
  9. You will be kept fasting for 6 hours. During this time you can take your medication with small sip of water. Otherwise you should not eat or drink any calorie containing food or drink.
  10. You may be advised about continuing of your routine medications. Blood thinning agents like aspirin, warfarin, Clopidogrel should be stopped as medical advice
  11. If you develop any symptom such as cold, cough or fever, let us know.
  12. On the surgery day morning, a doctor will review your history, examination, physical fitness, all investigations, preparations before you send to the theater.
  13. Your laparoscopic surgery will be done by an experienced laparoscopic surgeon in the operation theatre. Time taken for the surgery will depend on your surgery.
  14. After the operation, you will spend some time in the recovery room before going to the ward.
  15. In the ward, you will gradually come back to normal after fully recovery from anaesthesia. Then you can start waking up from the bed and start walking slowly and gradually start your routine activities. 
  16. After discharge, and if you are taking prescription for pain medicine, you are not permitted to: Drive a car nor operate power equipment , Drink alcohol, Sign important papers
  17. Instructions regarding safe resumption of the above activities will be provided by your surgeon.

Procedure

This surgery is performed under general anesthesia. So you will sleep throughout the procedure and won’t feel any pain. Anesthetic drugs will be administered via an intravenous cannula (cannula which is placed inside your hand) and provide good hydration with intravenous fluid (normal saline).

During laparoscopy, the gynecologist makes small incisions (cuts) of around 5-10 mm below or above your umbilicus (belly button) and then inserts a small port (a channel to pass instruments) This is used to inflate your abdomen (tummy) with carbon dioxide gas and that allows gynecologist to pass camera into your tummy to visualize organs locate inside your abdomen (tummy) more clearly and also provide more space to work. Through the camera, it displays the images on a screen, giving the surgeon a clear view of your abdominal and pelvic cavity.

If the laparoscopy is used to carry out a surgical procedure, then depending on your surgical procedure, you will get access ports through your tummy by making 1-4 small incisions (cuts) that are each between 5-10 millimeters in length. Laparoscopic instruments (Small surgical instruments) are inserted through these ports and the gynecological laparoscopic surgeon can perform the surgery without making any large abdominal incisions (cuts in your tummy).

After the procedure, the carbon dioxide is let out of your abdomen (tummy), the incisions (cuts) are closed using stitches or staplers and a dressing is applied.

Time takes to carry out a surgery varies according to the type of surgery. As an example when it uses for diagnostic purposes it usually takes 10-20 minutes and for therapeutic procedure it will take longer time, usually around 60-120 minutes.

Advantages of laparoscopic surgery

  1. Shorter hospital stay
  2. Smaller external scars
  3. Scars heal faster
  4. Less post-operative pain
  5. Reduced intra operative bleeding and handling
  6. Less adhesions ( scar tissue formation in between abdominal organs ) formation
  7. Able to share  the operative view with other doctors
  8. Quicker returns to activities

Disadvantages of laparoscopic surgery

  1. Expensive equipment. Not all hospital operating rooms can afford to it due to high cost.
  2. Need specially trained gynecologists and the team.
  3. Can’t performed in every patient

Complications

1. The anesthetic related complication
  • Anxiety
  • Vasovagal reaction
  • Pain
  • Allergic reactions and anaphylaxis
2. Induction of pneumo-peritoneum/ laparoscopic entry
  • Extra-peritoneal gas insufflation/ surgical emphysema
  • Mediastinal emphysema
  • Pneumothorax
  • Pneumo-omentum
  • Injury to gastro-intestinal tract
  • Bladder injury
  • Blood vessel injury
  • Gas embolism
3. Introduction of trocars and cannulae
  • Injury to vessels in the abdominal wall
  • Injury to an intra-abdominal vessel
  • Injury to a hollow viscus
  • Damage to other organs
4. Thermal damage
5. Injury from mechanical instruments
6. Other complications
  • Cervical laceration
  • Uterine perforation
  • Shoulder pain
  • Pelvic inflammatory disease
  • Omental and Richter’s herniation
  • Injuries from the operating table
  • Foreign bodies