Pelvic laparoscopy

Description

While you are deep asleep and pain-free under general anesthesia, the doctor makes a half-inch surgical cut in the skin below the belly button. Carbon dioxide gas is pumped into the abdomen to help the doctor see the organs more easily.

The laparoscope, an instrument that looks like a small telescope with a light and a video camera, is inserted so the doctor can view the area.

Other instruments may be inserted through other small cuts in the lower abdomen. While watching a video monitor, the doctor is able to:

• Get tissue samples (biopsy)
• Look around and diagnose the cause of any symptoms
• Remove scar tissue or other abnormal tissue, such as from endometriosis
• Repair or remove part or all of the ovaries or tubes
• Repair or remove parts of the uterus
• Do other surgical procedures (such as appendectomy, removing lymph nodes)

After the laparoscopy, the carbon dioxide gas is released, and the surgeon closes the cuts with stitches.

The average time of surgery depends on the procedure performed.

Why the Procedure is Performed

Laparoscopy uses a smaller surgical cut than open surgery. This means you will likely have a shorter hospital stay and quicker recovery. There is less blood loss with laparoscopic surgery and less pain after surgery.

Pelvic laparoscopy is used both for diagnosis and treatment. It may be recommended for:

• An abnormal pelvic mass or ovarian cyst found on pelvic ultrasound
• Cancer (ovarian, endometrial, or cervical) to see if it has spread or to remove nearby lymph nodes or tissue
• Chronic (long-term) pelvic pain, if no other cause has been found
• Ectopic (tubal) pregnancy
• Endometriosis
• Difficulty getting pregnant or having a baby (infertility)
• Sudden, severe pelvic pain

A pelvic laparascopy may also be done to:

• Remove your uterus (hysterectomy)
• Remove uterine fibroids (myomectomy)
• "Tie" your tubes (tubal ligation/sterilization)

Risks

General anesthesia poses the risk of reactions to medications, including breathing problems. Risks for any pelvic surgery include:

• Bleeding
• Blood clots in the leg or pelvic veins, which could travel to the lungs and, rarely, be fatal
• Breathing problems
• Damage to nearby organs and tissues
• Heart problems
• Infection

Before the Procedure

Always tell your doctor or nurse:

• If you are or could be pregnant
• What drugs you are taking, even drugs, herbs, or supplements you bought without a prescription

During the days before surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your doctor or nurse which medicines you can still take on the day of your surgery.
• If you smoke, try to stop. Ask your doctor or nurse for help.
• Arrange for someone to drive you home after surgery.

On the day of your surgery:

• You will usually be asked not to drink or eat anything after midnight the night before your surgery, or 8 hours before your surgery.
• Take the drugs your doctor or nurse told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital or clinic.

After the Procedure

You will spend some time in a recovery area as you wake up from the anesthesia.

Often, you will be able to go home the same day as the procedure. Sometimes, you may need to stay overnight.

Outlook (Prognosis)

The gas pumped into the abdomen may cause abdominal discomfort for 1 - 2 days after the procedure. Some people feel neck and shoulder pain for several days after a laparoscopy as the carbon dioxide gas irritates the diaphragm, a pain which is felt in the shoulder. As the gas is absorbed this pain will go away. Lying down can help decrease the pain.

Your doctor will give you a prescription for pain medicine or tell you what over-the-counter pain medicines you can take.

You may resume your normal activities in fewer than 2 days. Depending on what procedure is done, you can usually begin sexual activities again as soon as the bleeding (if there is any) has stopped. Ask your doctor what is recommended for the procedure you are having. Do not lift anything over 10 pounds for 3 weeks after surgery to decrease your risk of getting a hernia in your incisions.

Call your doctor if you have:

• Bleeding from the vagina
• Fever that doesn't go away
• Nausea and vomiting
• Severe abdominal pain

Alternative Names

Celioscopy; Band-aid surgery; Pelviscopy; Gynecologic laparoscopy; Exploratory laparoscopy - gynecologic

References

Katz VL. Diagnostic procedures, imaging, endometrial sampling, endoscopy: Indications and contraindications. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby; 2007: chap 11.

DeSimone CP, Ueland FR. Gynecologic laparoscopy. Surg Clin North Am. 2008;88:319-341.

Gaitán HG, Reveiz L, Farquhar C. Laparoscopy for themanagement of acute lower abdominal pain in women of childbearing age. CochraneDatabase of Systematic Reviews 2011, Issue 1. Art. No.: CD007683.

Jacobson TZ, Duffy JMN,Barlow D, Koninckx PR, Garry R. Laparoscopic surgery for pelvic pain associatedwith endometriosis. Cochrane Database of Systematic Reviews 2009, Issue 4. Art.No.: CD001300.

Update Date: 2/26/2012

Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.