Gynaecological Laparoscopy

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What is a Gynaecological Laparoscopy?
A gynaecological laparoscopy is a keyhole procedure that allows your surgeon to examine your pelvis (lower abdomen) including the fallopian tubes, ovaries and womb.

There are two types of laparoscopy:
• Diagnostic laparoscopy
• Operative laparoscopy

A diagnostic laparoscopy is an investigative operation and is usually undertaken to investigate things like abdominal/pelvic pain and to check in infertility cases that the fallopian tubes are patent (open).

An operative gynaecological laparoscopy may be used to:
• Treat endometriosis or pelvic inflammatory disease
• Remove an ectopic pregnancy
• Perform female sterilisation
• Remove an ovarian cyst/ovary and fallopian tube or take a biopsy
• Perform a key-hole hysterectomy (removal of the womb)

Your gynaecologist will explain the reason for undertaking a laparoscopy if it is for a different reason other than those listed above.

A laparoscope is a long, thin telescope with a light and a camera lens at the tip. It is passed through the abdomen usually through a small incision (cut) at the level of your umbilicus (tummy button). Your surgeon will examine your pelvis by looking either directly through the laparoscope or at pictures on a TV screen.

The examination is done under general anaesthetic; this means you will be asleep during the procedure.

All patients who require an elective laparoscopy will attend the hospital for a pre-assessment. This is usually undertaken at the time of your outpatient appointment when you are advised to undergo a gynaecological laparoscopy. This is carried out by an experienced nurse and involves a full health screen and will determine your fitness for the surgery and the anaesthetic.

If there are any concerns about your suitability for surgery (either medical or otherwise) your surgery may be delayed while we seek further advice or information. The nurse will tell you about this.

On the Day of the Surgery
Follow the instructions given to you in your letter from the admissions department. Please pay particular attention to the fasting instructions in the Treatment Centre booklet that you were given at your pre-assessment appointment. If you do not follow the fasting instructions your operation may need to be cancelled and rescheduled. Please remember to bring in a sample of urine in the pot given to you at the pre-assessment appointment. If you forget this you will be asked to give another sample of urine on admission and this may further delay your surgery if you cannot give a sample. Remember, it will be more difficult to supply a sample of urine because you have been fasting.

You will be seen by an anaesthetist and a member of the gynaecology team prior to your surgery. This is simply to ensure that you have been consented for the procedure and that you understand what is going to happen. Because of time restraints, it is not possible to answer in depth questions. If you have any questions please address these before the day of operation. One of the ward nurses will complete the admission paperwork and ask you further relevant questions. Before going to theatre you will be asked to remove jewellery, dentures, contact lenses and make up. You will
also need to put on a hospital gown and remove any underclothing.

When the theatre team are ready for you, you will be escorted to the theatre department where a member of the team will meet you and take you through to the anaesthetic room. You may be asked to walk down to theatre so please make sure you have suitable footwear and clothing such as a dressing gown.

About the Procedure
Diagnostic laparoscopies generally take about 45 minutes from start to finish. An operative laparoscopy will take longer as more is being done and is anything from 1 to 3 hours depending on the complexity of the surgery being undertaken. A diagnostic laparoscopy usually involves two to three cuts about 5 to 10 mm long. The first cut is made just in or below, your belly button. A hollow needle is inserted through this cut into your tummy. This is then connected to a supply of carbon dioxide gas, which is pumped through the needle and into the abdomen. This lifts the wall of the abdomen away from organs inside, making it easier and safer to insert the laparoscope and examine the pelvis.

If undergoing infertility investigations a special dye may be injected into the fallopian tubes via the cervix (neck of the womb) and the womb to help with the investigation. If undergoing an operative gynaecological laparoscopy, additional small cuts may be made to insert the necessary instruments. Usually there may be a cut in your bikini line and one or two at the side of your tummy (abdomen). Once the examination is complete, the instruments are removed along with as much gas as possible. The cuts are closed with either dissolvable stitches, special types of plaster and/or tissue glue.

What to Expect Afterwards
You will need to rest until the effects of the anaesthetic have passed. This will depend on the length of your operation and the type of surgery you have undergone. If you are uncomfortable or in pain, you may need painkillers. It is normal to have some vaginal bleeding after the procedure. If a dye was used, you may have a dark vaginal discharge for a day or two. This is nothing to worry about.

Going Home
You will usually be able to go home once you have made a full recovery from the anaesthetic. However, you will need to arrange for someone to drive you home, if your procedure has been scheduled as a day case and you are staying in the hospital for less than 24 hours. You should have a responsible adult stay with you for the first 24 hours. General anaesthesia can temporarily affect your coordination and reasoning skills so you should not operate machinery or make any major and/or important decisions for 48 hours afterwards.

You should not drive until you feel you could do an emergency stop without discomfort This will be dependent on the type of surgery you had and may be as little as 48 hours or longer than a week. If you are in any doubt about driving, please contact your motor insurer so that you are aware of their recommendations.

You will need to take it easy for a day or two. You will usually be able to return to work after a few days, but this depends on the exact treatment you have. A full recovery can take up to 7 – 14 days or longer. If you are given painkillers to take home, it is important for your recovery that you take them regularly as prescribed. It is advisable to avoid any vigorous exercise for between 2-
4 weeks. Always check with the gym instructor before resuming an exercise regime. Sexual activity can be resumed when you feel comfortable to do so.

Side-effects of the Procedure
Afterwards, you are likely to feel some pain in the abdomen as well as “referred pain” in the tips of your shoulders. This usually improves within 48 hours. You may have some abdominal bruising, which usually settles with time without treatment. Other common side effects include nausea and bloatedness.

Gynaecological laparoscopy is a commonly performed and generally safe procedure. For most women the benefits of improved symptoms or having a clear diagnosis are far greater than the disadvantages. However, in order to make an informed decision and give your consent, you need to be aware of the risk of complications. The main complications of any operation are bleeding,
infection, an unexpected reaction to anaesthesia or developing a blood clot in one of your legs (Deep Vein Thrombosis).

Although rare, it is possible during laparoscopic surgery that other organs in the abdomen (such as the bowel, bladder or major blood vessels) may be accidentally damaged. If this happens, it will be repaired at the time or when it is recognised. This will mean extra surgery.

It is also possible that during the operation the womb may be damaged or perforated. This can lead to bleeding and infection and may require further surgery and antibiotic cover There is a chance that your surgeon may need to convert your keyhole procedure to open surgery. This means making a bigger cut on your abdomen. This is only done if it’s impossible to complete the operation safely using the laparoscope. If you have any further questions related to your surgery please discuss these with your surgeon on your admission to hospital.

When to Seek Medical Advice
Laparoscopy and operative laparoscopy is now a common surgical procedure, which is generally safe, effective and well tolerated. However, as with any surgical procedure there can be complications and failures. The risk of these is less than 1%. If within 24 hours of being discharged you have severe abdominal pain and/or are vomiting (being sick), have a temperature and/or your abdomen (tummy) is getting more and more swollen and increasingly becoming more sore and tender to touch and/or it hurts badly when you cough please come back to the emergency department (ED) immediately for review.

These symptoms may have been caused by inadvertent damage to your bowel or bladder which can occur after a laparoscopy.

Shoulder tip pain
It is normal to experience a small amount of shoulder tip pain after a laparoscopy. However, if the shoulder tip pain is becoming worse to the point that it is severe come to the emergency department (ED) immediately to be reviewed.

You should seek advice if you have any of the following:
• Burning or stinging when you pass urine or passing urine frequently. This may be due to a urine infection; treatment is usually with a course of antibiotics.
• Red and painful skin around your scars. This may be caused by a wound infection. Treatment is usually with a course of antibiotics. However, it is normal to have a small amount of bruising around the wound which will settle in a week or two.
• A painful, red, swollen, hot leg or difficulty bearing weight on your legs. This may be caused by a deep vein thrombosis (DVT). If you have shortness of breath, chest pain or cough up blood, it could be a sign that a blood clot has travelled to the lungs (pulmonary embolus). If you have any of these symptoms, you should be reviewed by a doctor as an emergency. One of the biggest risks associated with air travel is DVT so a minimum of 10-14 days is recommended before air travel particularly after intra-abdominal surgery. Also, the head and lungs may be sensitive to pressure changes and there is free intra-abdominal air present in many patients after laparoscopy which can persist for up to a week.

You should expect a gradual improvement in your symptoms over time, if this is not the case you should seek medical advice.

Who should I contact if I am concerned about any of these symptoms?

In the first 24 hours you should seek advice from:
• The emergency department (ED)

After the first 24 hours you should contact:
• Your GP
• The Urgent Care Centre (01908 303030)
• 111

Most people recover very well following surgery although complications can occur. It can take longer to recover from a laparoscopy if:
• You had health problems before your surgery i.e. diabetes.
• If you smoke this can delay healing and increase your risk of a chest infection.
• If you were overweight at the time of surgery as it takes longer to recover from anaesthesia and may increase the risk of complications such as infection and thrombosis (Blood clot).
• If there were any complications during your surgery.

Getting Back to Normal
Whilst it is important to take enough rest, you should start some of your normal daily activities as soon as you feel able unless your doctor has instructed you otherwise. Your nurse will advise you if your wound has been closed with skin glue or dissolvable stitches. After bathing pat dry and do not use powders or creams on the area until healed. Most people will feel able to resume their previous activity levels by the second week following laparoscopy, any special instructions will be given on discharge. You should not drive a car for 48 hours due to the effect of anaesthetic gases. Check with your insurance company as they may have their own guidelines.

You may need to avoid some activities including sports for a short period of time. This will depend on your surgery and so please ask when you are discharged if this applies to you.

Day Surgery Unit 01908 995468 / 995469 (0700-2000)
Urgent Care Centre 01908 303030