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Gynaecological laparoscopy
Expert reviewer, Miss Shirin Irani, Consultant Gynaecologist
Next review due January 2021
A gynaecological laparoscopy is a procedure where your surgeon uses a camera (laparoscope) to see inside your lower abdomen (tummy). This means they will be able to see your uterus (womb), fallopian tubes and ovaries. They will also be able to see other parts of your body, such as your bladder and bowel.
As well as looking inside your abdomen, your surgeon can also use special instruments to do tests or treat certain gynaecological conditions. Gynaecological laparoscopy can be used to diagnose a condition and/or to treat it.
About gynaecological laparoscopy
Gynaecological laparoscopy can be used to find out what’s causing your symptoms, as well as treating several different conditions. These include:
- diagnosing and treating endometriosis
- removing scar tissue (adhesions) – scars can develop after infections such as pelvic inflammatory disease or because of endometriosis
- treating an ectopic pregnancy – this is where a fertilised egg starts to develop outside your womb
- sterilisation, which means closing your fallopian tubes so that you can no longer get pregnant
- removing an ovarian cyst
- removing your womb (hysterectomy) or ovaries (oophorectomy)
- treating fibroids
- investigating whether you may have cancer or whether cancer has spread
Your surgeon might take a small sample of tissue (biopsy) during the laparoscopy. This can be sent to a laboratory for testing to see what type of cells there are in it, and whether these are benign (not cancerous) or cancer. A biopsy can also help to diagnose endometriosis.
You may also have a gynaecological laparoscopy to find out the cause of any abdominal pain. If you’re trying for a baby, laparoscopy can be used to look for reasons why you might not be getting pregnant.
Deciding on gynaecological laparoscopy
This information can help you understand the pros and cons of having gynaecological laparoscopy. Think about how important each issue is to you, and then talk to your surgeon. You can work together to decide what's right for you. Your decision will be based on your surgeon’s expert opinion and your personal values and preferences.
Pros- Having a gynaecological laparoscopy may help to show what’s causing any symptoms you may have, or the cause of infertility.
- You may be able to have your condition treated in the same operation as your diagnosis.
- Compared to an operation such as a laparotomy, you may recover more quickly with less likelihood of complications.
Cons
- There is a risk that you’ll have some complications during or after the operation. These can include infection or damage to the organs in your abdomen.
- When you have a laparoscopy to try to diagnose a condition, it doesn’t always find the cause for your symptoms.
- You’ll need to have a general anaesthetic and are likely to need a few days off work.
Preparing for a gynaecological laparoscopy
You’ll 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.
Your surgeon will explain how to prepare for your procedure. For example, if you smoke, you’ll be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.
If you’re having a gynaecological laparoscopy to diagnose a condition, you’ll usually have it done and go home on the same day. If you have a gynaecological laparoscopy to treat a condition, you may need to stay in hospital overnight.
An anaesthetic can make you sick so it's important that you don't eat anything for six hours before your operation. You may be able to drink up to two hours before your surgery, but your anaesthetist or doctor will tell you what you need to do. If you have any questions, just ask.
At the hospital, your nurse will check your heart rate and blood pressure. They will also usually test your urine. This urine test is done to confirm that you are not pregnant. It also checks for certain conditions that could affect the procedure or your health.
You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may also need to have an injection of an anticlotting medicine as well as, or instead of, wearing compression stockings.
Your nurse or surgeon will discuss with you what will happen before, including any pain you might have. If you’re unsure about anything, just ask. No question is too small. Being fully informed will help you feel more at ease and will allow you to give your consent for the procedure to go ahead. You may be asked to do this by signing a consent form.
What are the alternatives to a gynaecological laparoscopy?
Gynaecological laparoscopy isn't suitable for everyone. Your surgeon may suggest alternative investigations or treatment if you:
- are very overweight
- are an older women (have been through the menopause)
- have had surgery on your abdomen before
- have a heart or lung condition
Depending on what’s causing your symptoms, there may be other investigations or treatments available. For example, your doctor may suggest painkillers and hormone treatments if you have endometriosis.
Before being offered a gynaecological laparoscopy, you may have an ultrasound scan. This can also be used to diagnose some gynaecological conditions, such as fibroids. You can have an ultrasound scan that looks at your womb from the outside, through your lower abdomen. You can also have one that looks at your womb from the inside using a device that goes into your vagina. Other investigations such as an MRI scan can also be used to diagnose conditions such as endometriosis.
One of the alternatives to laparoscopy is laparotomy. This is when your surgeon does open surgery by making a large cut in your abdomen. You might have a laparotomy if you need to be treated quickly, if you’re bleeding, for example. Or your surgeon might suggest a laparotomy for bigger operations, such as a hysterectomy.
Having a laparoscopy has some possible benefits compared to a laparotomy, such as smaller cuts and a faster recovery. However, for some women, laparotomy may be a better choice. Your surgeon will talk to you about the pros and cons of each.
Your surgeon will talk to you about your treatment or investigation options.
What happens during a gynaecological laparoscopy?
A gynaecological laparoscopy is usually done with a general anaesthetic. This means you’ll be asleep during the procedure.
Laparoscopy is sometimes called ‘key-hole surgery’. Your surgeon makes one or more small cuts in your lower abdomen. This usually includes one in your tummy button (navel).
A tube is put into one of the cuts and through this your surgeon will put carbon dioxide. This gently inflates your abdomen, so that your surgeon can see better. A small, flexible camera is put in through one of the cuts, so that your surgeon can see inside your abdomen. Your surgeon may put other special instruments in through the cuts if they need to take tissue samples or treat a condition.
At the end of the procedure, your surgeon will carefully take the instruments out of your abdomen and close the cuts with stitches or glue.
What to expect afterwards
You’ll need to rest until the effects of the anaesthetic have passed. You might have some discomfort as the anaesthetic wears off. But you'll be offered pain relief as you need it.
Having a general anaesthetic can really take it out of you. You might find that you're not so coordinated or that it's difficult to think clearly. This should pass within 24 hours. In the meantime, don't drive, drink alcohol, operate machinery or sign anything important.
You may have some bleeding from your vagina. You can use sanitary pads until the bleeding stops. If you have bleeding that is similar to a heavy period or you pass clots frequently for more than two days, you should phone the hospital and seek medical advice.
You’ll usually be able to go home after a few hours when you feel ready. Make sure someone can take you home. And ask someone to stay with you for a day or so while the anaesthetic wears off.
Your nurse will give you advice about caring for your wounds, hygiene and bathing. You may be given a date for a follow-up appointment.
If you have dissolvable stitches or glue on your wounds, these will dissolve on their own. If, on the other hand, you have non-dissolvable stitches, you’ll need to have them taken out after about five to seven days. You can usually have this done by a practice nurse at your GP surgery.
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 leaflet that comes with your medicine and, if you have any questions, ask your pharmacist for advice.
Rest and take it easy for the first 48 hours after your operation. If you’ve had a straightforward laparoscopy or one to diagnose a condition, you should be back to your usual activities in about a week. This includes going back to work. If you’ve had a more complicated procedure with treatment, it may take two or three weeks to feel like you’re back to normal. You should be able to have sex when you feel ready, unless your surgeon has given you specific advice.
It’s a good idea to keep moving around. You may not feel like it, but it will help prevent other problems later, such as blood clots in your legs or lungs. Your surgeon may also suggest you wear compression stockings or have blood thinning injections for a while after your operation. These help to prevent blood clots too.
You shouldn’t drive until any pain in your wound or from your operation has completely gone. Ask your surgeon for advice about when it should be safe for you to drive. If you’re in any doubt about driving, contact your motor insurer and the Driver and Vehicle Licensing Agency (DVLA) for more information.
If you feel unwell, or have any of the following symptoms once you’re at home, contact your GP or doctor for advice:
- a burning or stinging feeling when you pass urine, or passing urine often – this could mean you have a urine infection
- sore, red skin around your scars, which could be a sign of infection
- abdominal pain that’s getting worse, which could be a sign of damage to your bladder or bowel
- a red, swollen and painful lower leg, which could be symptoms of a blood clot in your vein (deep vein thrombosis or DVT)
Side-effects of gynaecological laparoscopy
You may have some side-effects. These are the unwanted but mostly temporary effects you may get after having a gynaecological laparoscopy. They include:
- a small amount of bleeding from your vagina
- pain and discomfort in your abdomen
- shoulder pain
- tiredness
- bruises around your wounds
- feeling sick (nausea)
Although it’s quite usual to feel a bit under the weather for the first couple of days after a laparoscopy, you should feel better soon after. If you keep feeling unwell and experiencing side-effects, contact the hospital for advice.
Complications of gynaecological laparoscopy
All medical procedures come with some risk. But how these risks apply to you will be different to how they apply to others. Be sure to ask for more information if you have any concerns.
Most women don’t have any problems after a gynaecological laparoscopy. If you’re having a laparoscopy to find out what is causing your symptoms, there is a chance that during the procedure your surgeon won’t see a clear reason for them. So, you may have the laparoscopy and still not know what is causing your symptoms.
Complications are when problems occur during or after your procedure. The possible complications of any operation include:
- an unexpected reaction to the anaesthetic
- excessive bleeding
- developing a blood clot, usually in a vein in your leg (deep vein thrombosis, DVT)
- an infected wound
Other complications of having a gynaecological laparoscopy are listed below.
- Other organs in your abdomen (tummy), such as your bowel, bladder, womb or major blood vessels, may be damaged during the operation.
- If there is a complication during your laparoscopy, your surgeon may need to change to open surgery. This means they will have to make a bigger cut on your abdomen.
- You may develop a urine infection.
- You may develop an incisional hernia near a wound. This is a bulge under your skin. It happens when tissue pokes through a wound that hasn't healed properly. A hernia can sometimes develop years after your operation.
Speak to your surgeon for more information about the complications that could occur and the symptoms to look out for after your surgery.
Frequently asked questions
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What does a gynaecological laparoscopy for sterilisation involve?
Sterilisation is surgery to stop you getting pregnant in the future. It’s a permanent form of contraception. It’s for women who decide they don’t want children, or who are certain they have completed their families and don’t want any more children.
Your surgeon will put a laparoscope into your abdomen through a cut in your tummy button (navel). They then make another cut and put in a special instrument which allows them to put on clips to close your fallopian tubes. Some surgeons may use heat from an electric current or another device instead of clips. By closing your fallopian tubes, it means that if you have unprotected sex, the sperm can’t reach the egg to fertilise it. If you’re thinking about sterilisation, it’s important to think through the decision carefully, to be as sure as you can that you're not likely to regret it in the future. The procedure is permanent and irreversible. You should be offered counselling, ideally with your partner, to help you think about and discuss all the pros and cons.
There are alternatives to having the operation, such as using other forms of contraception or your partner having a vasectomy. A vasectomy is a smaller operation where the tubes that carry sperm from the testicles to the penis are cut.
Your doctor can explain more about your options and answer any questions you may have.
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Related information
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Hysterectomy
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Other helpful websites
- Royal College of Obstetricians and Gynaecologists
www.rcog.org.uk
- Royal College of Obstetricians and Gynaecologists
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Sources
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Author information
Reviewed by Graham Pembrey, Lead Health Editor, Bupa Health Content Team, January 2018
Expert reviewer, Miss Shirin Irani, Consultant Gynaecologist
Next review due January 2021
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