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Laparoscopy

What is Laparoscopic surgery?

During laparoscopic surgery your doctor uses 3 to 5 small incisions, which are usually about 1cm long, and fills the abdomen with gas. A thin, lighted camera and small surgical tools are placed through the incisions to perform the surgery.

Laparoscopy is generally used to diagnose or treat disease in the pelvis which may include:

  • Endometriosis
  • Ovarian cyst removal
  • Ovaries that have twisted on its own blood supply
  • Adhesions
  • Ectopic pregnancy
  • Pelvic masses
  • Pelvic pain
  • Removal of pelvic organs (ovaries, fallopian tubes, uterus)
  • Tubal ligation (permanent sterilization)

What can I expect? Laparoscopy is generally an out-patient surgery. This means you can go home the same day after you are fully awake from anesthesia, which normally takes 1 to 2 hours. Most women are sent home with pain medications that include Norco and Motrin, as well as a stool softener called Colace.  Your doctor will remove as much of the gas as possible when the surgery is finished, but a small amount can remain. The remaining gas can irritate the diaphragm and may cause shoulder pain for a short time after the surgery. Photographs may be taken during the surgery and will be placed in your medical records.

We will make an appointment for you to see your surgeon about 2 weeks following your surgery.

How do I prepare for surgery?

  • Before surgery, a pre-op appointment will be scheduled with your doctor at their office or with a nurse practitioner or physician assistant at Domino Farms.
  • Depending on your health, we may ask you to see your primary doctor, a specialist, and/or an anesthesiologist to make sure you are healthy for surgery.
  • The lab work for your surgery must be done at least 3 days before surgery.
  • Some medications need to be stopped before the surgery. A list of medications will be provided at your pre-operative appointment.
  • Smoking can affect your surgery and recovery. Smokers may have difficulty breathing during the surgery and tend to heal more slowly after surgery. If you are a smoker, it is best to quit 6-8 weeks before surgery. If you are unable to stop smoking before surgery, your doctor can order a nicotine patch while you are in the hospital.
  • You will be told at your pre-op visit whether you will need a bowel prep for your surgery and if you do, what type you will use. The prep to clean your bowel will have to be completed the night before your surgery.
  • You will need to shower at home before surgery. Instructions will be provided at your pre-operative appointment.
  • Do not wear makeup, nail polish, lotion, deodorant, or antiperspirant on the day of surgery.
  • Remove all body piercings and acrylic nails.
  • If you have a “Living Will” or an “Advance Directive”, bring a copy with you to the hospital on the day of surgery.
  • Most women recover and are back to most activities in 4-6 weeks. You may need a family member or a friend to help with your day-to-day activities for a few days after surgery.

What can I expect during the surgery?

  • Once in the operating room, you will be given either a spinal and/or general anesthesia before the surgery to keep you from feeling pain. The choice of anesthesia is a decision that will be made by anesthesia based upon your history and your wishes.
  • If a general anesthesia is given, after you are asleep and before the surgery starts:
  • A tube to help you breathe will be placed in your throat.
  • Another tube will be placed in your stomach to remove any gas or other contents to reduce the likelihood of injury during the surgery. The tube is usually removed before you wake up.
  • A catheter will be inserted into your bladder to drain urine and to monitor the amount of urine coming out during surgery.
  • Compression stockings will be placed on your legs to prevent blood clots in your legs and lungs during surgery.
  • After you are asleep the laparoscope is inserted into the abdomen and carbon dioxide gas is blown into the abdomen to inflate the belly wall away from the internal organs.
  • After you are asleep the doctor will remove the uterus, and fallopian tubes. The ovaries are rarely removed, unless there is a medically necessary reason to remove them.  The surgery is done through the 4-5 small abdominal incisions.
  • Photographs may be taken during the surgery and will be placed in your medical records.

What are the risks of laparoscopy?

Although there can be problems that result from surgery, we work very hard to make sure it is as safe as possible. However, problems can occur, even when things go as planned, and you should be aware of these risks. 

Possible risks during laparoscopic surgery include:

  1. Bleeding: If there is excessive bleeding, you will be given a blood transfusion unless you have personal or religious reasons for not wanting blood. This should be discussed with your doctor prior to the surgery.
  2. Infection: The risk of a pelvic or skin infection related to laparoscopy is very low and antibiotics are generally not required. Sterile technique is used for all surgery to prevent infection.
  3. Damage to the bladder, ureters (the tubes that drain the kidneys into the bladder), and bowel: Damage occurs in less than 1% of surgeries, however the risk may be higher in patients with severe adhesions and/or endometriosis. If there is damage to the bladder, ureters, or bowel they will be repaired while you are in surgery. Some injuries may not be recognized at the time of surgery and may require another hospitalization and/or second surgery.
  4. Conversion to an open surgery requiring an up and down or bikini incision: If a bigger open incision is needed during your surgery, you may need to stay in the hospital for one or two nights.
  5. Death: All surgeries have a risk of death. Some surgeries have a higher risk than others.

Additional risks during laparoscopic surgery for an ovarian cyst:

If you have a cyst there is a small chance that the cyst will rupture or break open during the surgery. In the event this happens we clean very well as the cyst fluid can cause irritation to the inside of the abdomen. If the ovarian cyst were unexpectedly cancerous, rupture may lead to increased spread of cancer. There is also a small chance that we are unable to remove the cyst alone and must remove the ovary as well.

If the ovary is removed, there is a small chance that a small amount of ovarian tissue can be left behind, which is called an ovarian remnant. Ovarian remnants may cause recurrent ovarian cysts and/or pelvic pain.

Possible risks that can occur days to weeks after surgery:

  1. Urinary retention: Inability to feel the urge to urinate and/or empty your bladder. This is usually temporary and usually resolves in 12-72 hours after the surgery. Prior to discharge, the nursing team will check and make sure that you can adequately empty your bladder. If you are unable to adequately empty your bladder after surgery, you will need to use a catheter to drain your bladder until your symptoms resolve. If this occurs, our nurses will teach you how to do this safely before going home.
  2. A blood clot in the legs (deep venous thrombosis, DVT) or lungs (pulmonary embolus, PE): Swelling or pain in your legs, shortness of breath, or chest pain are possible signs of blood clots. This is considered an emergency. Call you doctor immediately if you experience swelling or pain in your legs. Call 911 or go to the nearest emergency room if you develop chest pain or shortness of breath.
  3. Bowel obstruction: A block in the bowel that results in not being able to pass stool or gas. May cause stomach pain, bloating or vomiting. This may require hospitalization or another surgery.
  4. Infection: This includes infection of the bladder, kidneys, skin or the site of surgery. This may cause fever, redness, swelling or pain. This may require treatment with antibiotics, admission to the hospital, and possible drainage of infected tissue or fluid.
  5. Hernia: Weakness in the muscle at the incision that allows a piece of intestine or the tissue around them to pass through. This can cause a lump under the skin and sometimes, an organ or tissue gets stuck in the hernia, which can cause problems.
  6. Persistent pain that does not get better after surgery. Or, onset of new pelvic or abdominal pain that was not present before surgery.
  7. 7. Failure to relieve symptoms or recurrence of the symptoms for which you are having surgery.
  8. 8. Development or recurrence of scar tissue