Laparoscopy is a type of surgical procedure in which the inside of the abdomen and pelvis is accessed by small, thin instruments without making any large cut on the skin. It is a type of minimally invasive surgery. The procedure is done with the use of a laparoscope, which is like a thin telescope fitted with a light source and a camera. It is passed into the abdomen through a small cut on the skin, usually made just below the umbilicus (belly button), and the images are then magnified and projected on a screen for the doctor to see. The cut made is about 1-2cm long.
A harmless gas is infused through the small cut, which lifts the wall of the abdomen off the organs and makes it easier for the surgeon to see. The surgery is then performed with the aid of similar small instruments inserted into cuts at other positions on the abdomen. After the procedure, the gas is let out of the abdomen and the skin is closed up. The average duration of the surgery is about 2 hours.
A laparoscopy can either be used as an investigative tool, or to treat a condition that has already been diagnosed. Some of the procedures that can be done with a laparoscopy include:
- Investigation for infertility
- Investigation for unexplained pelvic pain or abdominal pain
- Removal of fibroids located on the outside of the womb or within the wall of the womb (called subserosal and intramural fibroids respectively) – Laparoscopic Myomectomy
- Treatment of endometriosis; when small pieces of the lining of the womb (endometrium) are found outside the womb
- Treatment of adhesions (scar tissue) in the abdomen – Laparoscopic Adhesiolysis
- Treatment of ectopic pregnancy; when a pregnancy develops outside the womb, commonly in one of the tubes. This is usually performed as an emergency
- Removal of damaged tubes – Laparoscopic salpingectomy
- Removal of ovarian cysts – Laparoscopic ovarian cystectomy
- Removal of the ovaries – Laparoscopic oophorectomy
- Treatment of Pelvic Inflammatory Disease
- Removal of the uterus – Laparoscopic Assisted Vaginal Hysterectomy
To confirm that you are fit for surgery, some tests will be done to check your blood level, heart and kidney functions, blood group, and blood clotting function. These tests are done at a clinic visit on a separate day before the procedure. The doctor will explain to you in more detail what is going to happen and answer any questions you have, after which a consent form (a document stating your agreement to the procedure) will be signed. If an abnormality is detected or if you have been known to have a previous illness, you might need to be seen by another doctor to be cleared for surgery. If your blood level is low, you will be placed some tablets or injections to raise the blood level, or to prevent you from having another period, so that the blood level doesn’t drop further. Once everything is satisfactory, a date can be fixed.
Laparoscopic surgeries can only be done under general anaesthesia. This means that you will have to be put to sleep.
You will be instructed not to eat or drink anything from 12 midnight on the day of the surgery. While you can come into the hospital on your own on the morning of the surgery, you will need to make arrangements for someone to take you home afterwards. Most laparoscopies are done as day cases, which means that you will be able to go home on the same day, about 2 to 3 hours after the procedure. However, after more extensive laparoscopies e.g. a laparoscopic myomectomy, you will be on admission for one or two more days.
After a laparoscopic procedure:
- You would be able to go back to work after a few days, or about 1 to 2 weeks, depending on the specific procedure that was done.
- You will be discharged home with antibiotics and pain relieving tablets
- You may have some shoulder pain for a few days. This is because the gas used during the procedure can irritate the diaphragm, which shares some of the same nerves as the shoulder. It will resolve in a few days
- You will be seen again in the clinic for a review, usually after 1, 2, or 4 weeks, depending on the findings at surgery
- There is not much pain afterwards, but you will need to take things easy for a while and refrain from vigorous activities to allow your body to recover
- Most people feel well enough to resume their normal activities and return to work a week after the operation.