Gynaecological laparoscopy

Published by Bupa's Health Information Team, October 2010.

This factsheet is for women who are having a gynaecological laparoscopy, or who would like information about it.

A gynaecological laparoscopy is a procedure that allows a surgeon to examine the fallopian tubes, ovaries and womb (uterus). A laparoscopy can be used to either diagnose a condition, or to treat it.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About gynaecological laparoscopy

Gynaecological laparoscopy is a procedure used to look inside your abdomen (tummy) and examine your fallopian tubes, ovaries and womb.

A medical telescope with an attached camera, called a laparoscope, is put into your abdomen through a small cut in your belly button (umbilicus). The pictures from the camera are sent to a television screen and magnified, so that your surgeon can clearly see the organs inside your abdomen. Gynaecological laparoscopy can be used either to diagnose a condition or to treat a condition.

Gynaecological laparoscopy can be used to:

• diagnose and treat endometriosis, a condition where the lining of your womb grows outside your womb
  
• diagnose and treat pelvic inflammatory disease - inflammation of your ovaries, womb or fallopian tubes
  
• diagnose and remove scar tissue (adhesions)
  
• treat an ectopic pregnancy, a condition where a fertilised egg implants outside your womb
  
• carry out female sterilisation, which is permanent contraception
  
• remove an ovarian cyst
  
• remove your womb or ovaries (hysterectomy)
  
• treat fibroids - non-cancerous growths on or inside your womb
  
• remove lymph nodes for cancer treatment

Your surgeon may also suggest a laparoscopy if you have pain in your abdomen because it may help to diagnose what is causing the pain. If you're having problems getting pregnant, you can have a laparoscopy to see if there are any problems with your ovaries, fallopian tubes or womb.

What are the alternatives?

Depending on your symptoms and circumstances, there may be other investigations or treatments available.

Ultrasound can also be used to diagnose some of these conditions such as fibroids. This investigation uses sound waves to produce an image of the inside of part of the body. There are two types of ultrasound that can be used to diagnose a gynaecological problem. Abdominal ultrasound is when the ultrasound probe is moved over your abdomen. A trans-vaginal ultrasound is where the ultrasound probe is put into your vagina to produce images of the inside of your abdomen.

If you need to have treatment, you may be offered a different type of surgery. For example, you can have your womb removed by your surgeon making a large cut in your lower abdomen (abdominal hysterectomy) or by making a cut in the top of your vagina (vaginal hysterectomy).

Your surgeon will explain the different options to you and discuss which option is best for you.

Preparing for a gynaecological laparoscopy

Your surgeon will explain how to prepare for your procedure. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest infection or wound infection and slows your recovery.

If you're having gynaecological laparoscopy to diagnose a condition, you will usually have it done as a day-case procedure. This means you have the procedure and go home the same day. If you need to have a gynaecological laparoscopy to treat a condition, you will usually need to stay overnight.

A gynaecological laparoscopy is usually done under general anaesthesia, which means you will be asleep during the procedure. You will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your surgeon's advice.

At the hospital, your nurse may do some tests such as checking your heart rate and blood pressure, and testing your urine.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

If you're having a laparoscopy to diagnose your condition or because you have abdominal pain, your surgeon may go on to treat your condition during the procedure. He or she will talk to you about any possible treatment before your operation, and you will be asked to sign a consent form that includes the possible treatments.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.

What happens during a gynaecological laparoscopy

The procedure can take 15 minutes or more, depending on what type of examination or treatment you need.

Your surgeon will make a cut in your belly button. He or she will put a tube through the cut and pump in some gas. This expands your abdomen, separates your organs and makes it easier for your surgeon to look at your organs with the laparoscope. If you need any treatment, or if your surgeon needs to move some of the organs to get a good view, he or she will make some small cuts lower down on your abdomen. Any surgical instruments that are needed for treatment can be inserted through these cuts. Your surgeon may inject a coloured dye through your cervix and into your womb and your fallopian tubes. This shows whether your fallopian tubes are blocked.

At the end of the procedure, your surgeon will carefully take the instruments out of your abdomen and allow the gas to escape through the laparoscope. He or she will close the cuts with stitches.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours after your laparoscopy. Your nurse will give you some advice about caring for your wounds, hygiene and bathing before you go home. You may be given a date for a follow-up appointment.

Your surgeon may use dissolvable stitches. The length of time your dissolvable stitches will take to disappear depends on what type you have. However, for this procedure they should usually disappear in seven days. If they cause skin irritation, then your doctor can remove them after this time. If you have non-dissolvable stitches you will need to have them taken out. Your surgeon will tell you when and where to have them removed.

Recovering from a gynaecological laparoscopy

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.

If you have a laparoscopy to diagnose a condition you will need to rest and take it easy for two or three days. If you have had treatment during the laparoscopy - for example, if you have had treatment of endometriosis or a hysterectomy, your recovery will take longer. It usually takes about one to four weeks to make a full recovery from a gynaecological laparoscopy, but this varies between individuals and procedures, so it's important to follow your surgeon's advice.

You shouldn't lift anything heavy for four weeks after your operation. Follow your surgeon's advice about contraception and when you can have sex again.

What are the risks?

Gynaecological laparoscopy is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. You're likely to feel some pain in your abdomen. You may also have pain in your shoulders. This is caused by the gas used to inflate your abdomen; it usually gets better within 48 hours.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. You may have some bruising on your abdomen around the areas where the laparoscope and any surgical instruments were put in. This usually gets better without treatment.

Complications

This is when problems occur during or after the procedure. Most women aren't affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

The other main complications of having a gynaecological laparoscopy are listed below.

• Your wounds may not heal properly or they may become infected.
  
• You may develop a hernia.
  
• Other organs in your abdomen, such as your bowel, bladder, womb or major blood vessels, may be damaged during the operation. However, this is uncommon.
  
• During your laparoscopy, your surgeon may need to change to open surgery. This means making a bigger cut on your abdomen. This is done if it's impossible to complete the procedure safely using the laparoscope, or if there is a complication during laparoscopy that requires a larger cut to be made on your abdomen.

Most women experience no problems after having a gynaecological laparoscopy. However, if you develop any of the following symptoms, contact your doctor:

• severe pain or pain that gets worse
  
• a swollen abdomen
  
• high temperature
  
• wound redness or discharge

The exact risks are specific to you and will differ for every person, so we haven't included statistics here. Ask your surgeon to explain how these risks apply to you.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.