Laparoscopy

What is Laparoscopy?

Laparoscopy, also known as keyhole or minimally invasive surgery, is a surgical procedure that allows your doctor to examine and treat conditions inside the abdomen and pelvis through very small incisions. A thin instrument called a laparoscope, which contains a high-definition camera and a light source, is inserted through a small incision (usually near the navel). The camera projects magnified images onto a screen, allowing the surgeon to see the organs clearly without the need for a large abdominal incision.

In gynaecology, laparoscopy is widely used to diagnose and treat conditions affecting the uterus, ovaries, fallopian tubes, and surrounding pelvic structures. It can serve as both a diagnostic tool (to identify the cause of symptoms) and an operative procedure (to treat the identified problem simultaneously).

Why Consider Gynaecological Laparoscopy?

Laparoscopy is particularly valuable when ultrasound, X-rays, MRI, or CT scans cannot fully explain symptoms such as pelvic pain or infertility.

It can help investigate and manage:

• Pelvic pain: Including pain caused by adhesions (scar tissue), endometriosis, ovarian cysts, infections, or ectopic pregnancy.
• Infertility: To assess the fallopian tubes, ovaries, and pelvic anatomy; dye may be injected through the cervix during the procedure to confirm that the tubes are open.
• Endometriosis: To confirm the diagnosis and remove endometriotic deposits.
• Fibroids: Especially those affecting fertility or causing pain and bleeding.
• Ovarian cysts or tumours: To remove cysts or assess suspicious masses.
• Ectopic pregnancy: To treat a pregnancy located in the fallopian tube.
• Pelvic inflammatory disease (PID): To assess the extent of infection and scarring.
• Unexplained pelvic abnormalities: Including gastrointestinal, urinary, or musculoskeletal conditions contributing to pain.

Laparoscopy allows direct visualisation of the pelvis and abdomen, including the bladder, bowel, appendix, liver, stomach, and diaphragm if required.

Who is Suitable for Laparoscopy?

Laparoscopy may be recommended for women who:

• Have ongoing pelvic pain not explained by imaging.
• Are experiencing infertility requiring further investigation.
• Have suspected endometriosis, adhesions, or ovarian cysts.
• Require surgical treatment of fibroids or other pelvic conditions.

However, laparoscopy may not be suitable in certain circumstances, including:

• Severe obesity which may make access difficult.
• Extensive previous abdominal surgery leading to dense adhesions.
• Advanced pregnancy.
• Active abdominal infection.
• Significant blood-clotting disorders.

A thorough medical assessment, including review of your medical history, physical examination, and investigations such as blood tests and imaging, will determine whether laparoscopy is appropriate for you.

Benefits of Laparoscopy

Compared with traditional open surgery, laparoscopy offers:

• Smaller incisions: Less tissue trauma and improved cosmetic outcome.
• Reduced postoperative pain: Leading to lower need for strong pain medication.
• Shorter hospital stay: Many procedures are performed as day surgery or require only an overnight stay.
• Faster recovery: Most women return to work within about one week, depending on the procedure performed.
• Reduced blood loss: Lower risk of transfusion.
• Lower infection risk: Smaller wounds reduce exposure.
• Enhanced visualisation: Magnified camera views provide a detailed assessment.
• Lower risk of adhesions: Compared with open surgery.

Types of Laparoscopy

• Diagnostic Laparoscopy: Used to identify the cause of symptoms such as pelvic pain or infertility.
• Operative Laparoscopy: Used to treat conditions such as removing cysts, fibroids, fallopian tubes, ovaries, treating endometriosis, or performing sterilisation.

Alternative Options to Laparoscopy

Depending on your condition, alternatives may include:

• Medical management: Hormonal or other medications.
• Imaging investigations: Ultrasound, MRI, or CT scans.
• Hysteroscopy: Examination of the uterine cavity via the vagina and cervix.
• Open surgery (laparotomy): For complex cases requiring wider access.

Your doctor will discuss which option is most appropriate based on your symptoms and goals, particularly regarding fertility.

Laparoscopy vs Laparotomy

• Laparoscopy: Uses small incisions (usually 5–10 mm), results in less pain, minimal scarring, and faster recovery.
• Laparotomy: Involves a larger abdominal incision to access organs directly. It may be necessary for more complex or extensive conditions.

In some cases, a laparoscopy may need to be converted to open surgery (laparotomy) if unexpected findings arise or if safety requires better access.

What to Do Before a Laparoscopy?

Before surgery, you will:

• Attend a pre-operative consultation: The procedure, risks, benefits, and alternatives will be discussed.
• Undergo medical review: Including blood tests, imaging, and sometimes an ECG.
• Receive fasting instructions: Usually, no food or drink for several hours before surgery.
• Arrange transport home: As you cannot drive after general anaesthesia.

You may also be advised to temporarily discontinue certain medications.

Laparoscopy Procedure

Laparoscopy is performed in an operating theatre under general anaesthesia.

During the procedure:

• Small incisions are made: Usually one near the belly button and two to three additional small cuts (around 5 mm each).
• Carbon dioxide gas is introduced: To gently inflate the abdomen and create working space.
• The laparoscope is inserted: Providing magnified views of the pelvis and abdomen.
• Surgical instruments are introduced: Through other incisions to treat the condition if required.
• Tubal dye test may be performed: To assess fallopian tube patency.
• Incisions are closed: With sutures and covered with waterproof dressings.

The procedure duration depends on complexity and typically ranges from 30 minutes to two hours.

What to Expect After a Laparoscopy?

After surgery:

• Recovery room monitoring: Until you wake from anaesthesia.
• Shoulder tip pain: Common for 24 hours due to gas irritating the diaphragm.
• Bloating and mild abdominal discomfort: For several days.
• Fatigue: Often lasting about five days.
• Return to work: Usually within seven days for minor procedures.

Waterproof dressings allow you to shower. Avoid heavy lifting or strenuous exercise for at least one to two weeks, gradually increasing activity as advised.

A follow-up appointment is typically scheduled within one week to review findings, pathology results, and photographs taken during surgery.

When to Seek Urgent Medical Attention?

Contact your doctor or attend the nearest emergency department if you experience:

• Fever
• Heavy bleeding or offensive discharge
• Severe abdominal pain
• Persistent nausea or vomiting
• Difficulty passing urine or bowel motions
• Shortness of breath or leg swelling

Laparoscopy Prognosis and Recovery

The prognosis after laparoscopy is generally very favourable. Most women recover quickly with fewer complications than traditional open surgery. Full recovery varies depending on the complexity of the procedure, but most resume normal activities within one to four weeks.

Laparoscopy remains the preferred approach for diagnosing and managing many gynaecological conditions because it balances safety, precision, and faster healing.

Laparoscopy Risks and Complications

Although laparoscopy is generally safe, possible risks include:

• Infection
• Bleeding
• Injury to bowel, bladder, ureter, or blood vessels
• Anaesthetic complications
• Blood clots (deep vein thrombosis)
• Conversion to open surgery if necessary.

Serious complications are uncommon, particularly when performed by experienced gynaecological surgeons.

What if Laparoscopy is Delayed?

Delaying surgery may be appropriate in certain situations, such as when medical conditions must first be stabilised. However, postponing treatment can sometimes allow underlying conditions to worsen. For example:

• Untreated endometriosis: May progress and affect fertility.
• Ongoing pelvic infection: Can cause increasing scarring.
• Persistent ovarian cysts: May grow larger or rupture.

Timely evaluation ensures optimal outcomes and may prevent the need for more complex surgery later.