What is laparoscopy?
Radiological (X-ray) and ultrasound investigations are used to diagnose many conditions within the abdomen and pelvis, but they do have their limitations.
Under certain circumstances, a clearer picture of the appearance of the abdomen and pelvis is required.
A laparoscopy enables the surgeon or gynaecologist to directly view the organs of the abdomen and pelvis.
How is a laparoscopy performed?
Laparoscopy is performed under a general anaesthetic.
A small cut is then made in or just below the belly-button measuring between 1 to 2cm. Through this the laparoscope is inserted gently into the abdomen.
The laparoscope is a sterile surgical instrument that has special optics that allow small amounts of light to be transmitted effectively.
Carbon dioxide gas is pumped through a channel in the laparoscope into the abdomen.
This creates a space within which the surgeon can look or operate. Additional instruments are often required.
These are usually introduced via even smaller cuts in the skin above or to the side of the pubic hair.
What can a laparoscopy be used for?
Many laparoscopies are performed as part of the investigation of abdominal or pelvic pain.
Laparoscopy can be used to diagnose conditions such as endometriosis and pelvic inflammatory disease.
As well as being a diagnostic procedure, laparoscopy can also be used to remove cysts on the ovaries and also free adhesions caused by ovarian diseases or other disease of the pelvic organs.
Most sterilisations today are performed through a laparoscope. It is also used for surgical management of most ectopic pregnancies.
Laparoscopic surgery is becoming increasingly popular with patients because the scars are smaller and generally the length of hospital stay is less also.
Laparoscopic surgery requires special training of the surgeon or gynaecologist and the theatre nursing staff. The equipment is often expensive and not available in all hospitals.
How does the patient feel after a laparoscopy?
There is usually pain around the cuts in the skin and often a sense of general discomfort over the abdomen.
Many patients report pain at their shoulder-tip, which is due to the indirect effect of small amounts of carbon dioxide remaining in the abdomen.
Pain relief is always given. Many patients go home from hospital the same day the laparoscopy is performed.
What are the risks associated with laparoscopy?
There's no such thing as a totally risk-free investigation or operation.
The risk of the general anaesthetic is extremely low if the patient is in good general health.
The risks of laparoscopy include accidental damage to the bowel or blood vessels within the abdomen or pelvis. These complications affect between one to two people per thousand cases and require immediate further surgery to correct any damage.
Minor complications include bleeding or bruising around the skin cuts or bruising of the skin at the front of the abdomen. The surgeon or gynaecologist will explore all the risks of laparoscopic surgery with the patient prior to signing the consent form.
Serious risks include:
the overall risk of serious complications from diagnostic laparoscopy, approximately two women in every 1000 (uncommon) damage to bowel, bladder, uterus or major blood vessels which would require immediate repair by laparoscopy or laparotomy (uncommon). However, up to 15 percent of bowel injuries might not be diagnosed at the time of laparoscopy failure to gain entry to abdominal cavity and to complete intended procedure hernia at site of entry death; three to eight women in every 100,000 undergoing laparoscopy die as a result of complications (very rare).
Frequent risks include:
Any extra procedures that may become necessary during the procedure:
Repair of damage to bowel, bladder, uterus or blood vessels.