Gynaecological Laparoscopic Surgery

Introduction

The laparoscope is a fibre-optic telescope designed to allow the surgeon to visualize and examine the organs lying within the pelvic and abdominal cavities. Laparoscopy is the term used to describe the operative procedure and may be used to aid diagnosis where this cannot be made by physical examination or symptom description and to facilitate treatment for some gynaecological conditions.

Indications

Diagnostic Laparoscopy can be used for:

• Investigation of pelvic pain
• Investigation of infertility
• Examination of cysts and tumours
• To obtain biopsy samples
• To investigate suspected ectopic pregnancy

Operative Laparoscopy is utilised:

• To achieve female sterilisation
• For treatment of ectopic pregnancy
• To release/remove pelvic or abdominal adhesions
• To surgically treat endometriosis
• To excise or drain ovarian cysts
• To remove fibroid (benign) tumours from the uterus
• To enhance fertility eg: assisted reproductive techniques
• To facilitate hysterectomy
• To reconstruct the pelvic floor, treat prolapse and incontinence

At times a surgeon may extend a diagnostic procedure and undertake concurrent laparoscopic operative surgery to improve treatment, speed recovery and to avoid further hospitalisation and anaesthesia. In such cases your gynaecologist is likely to have discussed this possibility before surgery. Other operations are sometimes performed in conjunction with laparoscopy - For example:

• Dilatation and curettage (D & C - stripping of the uterine lining)
• Hysteroscopy (telescopic examination of the uterine lining)
• Dye perfusion (passing dye through the fallopian tubes to check on tubal patency)

In all of these situations your surgeon will discuss the additional procedure.

How is laparoscopic surgery performed?

Most frequently the operation is performed under light general anaesthesia and the patient is seen prior to surgery by the specialist anaesthetist who will explain that part of your operation. Prior to operation, medication is sometimes given to help you feel relaxed before your trip to the operating theatre.

After preparing the skin area with antiseptic solution a small cut is made just below the umbilicus (navel) and through this incision the operating telescope (laparoscope) is inserted. During the operation carbon dioxide gas is introduced to distend the abdominal and pelvic cavity to create a space in which the organs can be seen.

When necessary, separate small incisions are made low down and at the sides of the abdomen to allow insertion of other fine instruments, e.g. grasping forceps, scissors, etc., and these will enable organs and tissue to be grasped, moved or cut as is required for your surgery.

At the conclusion of the surgery and after the instruments are removed, the carbon dioxide gas is encouraged to escape from the cavity and the incisions are closed with sutures or steristrip tape. Small dressings are often applied to cover these wounds.

Post-operative course recovery

Patients are transferred from the operating theatre to our recovery ward where they will be closely observed for a few hours in the immediate post-operative phase. During this time they may experience some shoulder-tip discomfort, a feeling of abdominal distension and pain. Often injected pain relief is necessary and some patients may also need anti-emetic (anti-vomiting) medication.

Most frequently the procedure can be regarded as day case surgery, but in some cases an overnight stay is advisable. As is normal, patients are strongly advised not to drive or undertake strenuous physical activity within 24 hours of laparoscopic surgery, and in some operative procedures a longer convalescent interval will be required.

Some patients feel fatigue or muscle pain which may last a few days, but the shoulder-tip and pain under the ribs caused by the carbon dioxide gas distension is generally gone in 24 hours as is any discomfort in the incision sites. Mild menstrual cramps are reported by some women and a few days of vaginal bleeding and a mild sensation of abdominal swelling is commonplace. Simple pain relief medication should be taken if necessary.

Normal physical activity and sexual intercourse may be resumed when the patient feels well and comfortable.

Your gynaecologist will usually want to undertake a post-operative examination at six weeks and may also suggest other follow-up arrangements.

Risks and complications

No surgical procedure is entirely without risk, but this type of surgery attempts to minimise such risks. Complications such as damage to other organs (bowel or bladder) and bleeding are rare events and are likely to have been recognised during the operation and appropriately corrected. Very rarely such damage occurs as a late post-operative complication and further hospitalisation and/or surgery is required. Anaesthesia itself has some slight risks and these are made worse by severe obesity or cigarette smoking.

Conclusion

In general, laparoscopic surgical techniques allow excellent diagnostic inspection of abdominal and pelvic organs and facilitate operative correction of gynaecological disorders without the necessity for large abdominal incisions, prolonged hospitalization and protracted recuperation.

The gynaecologists at the Oxford Clinic are skilled in advanced laparoscopic surgical techniques and encourage you and your partner to discuss your planned surgery and expectations with them. They welcome input from your family practitioner and will ensure that he or she is aware of our surgery and expected post-operative course.