Common Procedures

Laparoscopy

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Laparoscopy is an inspection of the pelvic organs through a telescope. It is often performed as an investigation to determine the cause for pelvic pain or to check the fallopian tubes are open as part of the investigation of fertility problems.

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How is it carried out?

Two small cuts are made under general anaesthetic (about 1cm long). Carbon dioxide is introduced into your abdomen to enable the pelvic organs (uterus, fallopian tubes and ovaries) to be seen clearly. A small telescope (the laparoscope) is introduced through the small cut at the navel and a probe is often inserted through the lower cut to help inspect the pelvic organs.

Laparoscopy does not always identify the cause for pelvic pain, your consultant will discuss further investigations or treatments that are available.

After your laparoscopy procedure

• Some discomfort around the incision is common. You may also experience a feeling of bloating in your abdomen and discomfort in your shoulders. You can take painkillers, such as paracetamol, for this. These feelings should disappear completely within a few days.
• You may also have slight vaginal bleeding for a few days.
• You may have slight vaginal bleeding for a few days. It is advisable to sus sanitary towels rather than tampons for this.
• The stitches will dissolve within a week or two. The lower one is often just a puncture mark and there is no stitch. You may have a small amount of bleeding from these cuts. If there is no bleeding through the plaster, they may be removed and no further dressing is needed. After bathing dry these areas thoroughly.
• You should stay off work for a few days, returning only when you feel ready.
• Do not drive for 48 hours.
• If you are discharged the same day, avoid drinking alcohol or signing important documents until after the anaesthetic has worn off, usually 24 hours.
• Do arrange for someone to stay with you for the first night after your operation.
• You will normally have a post-operative appointment in approximately 10 days.

Laparoscopy and dye test

Laparoscopy and dye test is an operation using a small telescope to look at your abdominal and and pelvic organs, particularly your fallopian tubes. In some circumstances minor treatments can be performed at the same time.

Your consultant has recommended this operation to help find out why you are having difficulty becoming pregnant.

A laparoscopy and dye test is usually performed under a general anaesthetic. Your surgeon may empty your bladder using a catheter (small tube) and may also perform a vaginal examination.

A small hole will be made near your tummy button and an instrument will be inserted which inflates the abdominal cavity with gas (carbon dioxide).

A further hole is usually made in the ‘bikini’ line, so that tubes (ports) can be inserted into your abdomen.

Instruments are place through these holes along with a telescope. This allows the surgeon to see inside the abdomen and perform minor procedures if needed. Sometimes one or two further holes may be made depending on the surgery you need.

A special instrument is also inserted into the cervix (neck of the womb). A dye is injected, which passes through the cervix, uterine cavity and down the Fallopian tubes.

The surgeon watches the dye filling and spilling out of the Fallopian tubes on a television monitor.

At the end of the operation the gas and instruments are removed and the small holes are closed with stitches or something similar such as skin glue.

The test will show if your fallopian tubes are blocked and may identify other conditions associated with infertility. The laparoscopy will help to find out if you have one of the following conditions:

• Endometriosis – a condition where the lining of the womb grows outside the womb
• Pelvic infection
• Adhesions around the tubes of ovaries.
• Ovarian cysts
• Fibroids – a fibroid is an overgrowth of the muscle of the womb

The alternatives to surgery is by an x-ray called a hysterosalpingogram can be done to see if your tubes are blocked.

These techniques are not suitable for all patients as they only show if the tubes are blocked.

They cannot show if there are any other conditions affecting your pelvic organs that may be causing your infertility.

What risks or complications can occur?

The risks and complications fall into three categories:

• Complications of anaesthesia
• General complications of any operation
• Specific complications of this operation

General complications of any operation

• Pain – which occurs with every operation. Efforts will be made to minimise the pain. You will be given medication to control the pain. You will be given medication to control the pain and it is important that you take it as instructed so you can move about as advised. After a laparoscopy it is common to have some pain in the shoulders due to a small amount of gas staying under the diaphragm after the operation. The body usually absorbs the gas naturally over the next 24 hours, which will ease the symptoms.
• Bleeding during or after the operation. This rarely needs a blood transfusion or another operation.
• Infection in the surgical wound, which is easily treated with antibiotics. Infection of gynaecological organs or bladder (cystitis). This is rare but may need antibiotics.
• Unsightly scarring of the skin. This is rare.
• Blood clots in the legs (thrombosis), which can occasionally move through the bloodstream to the lungs (embolus), causing breathing difficulties.

Specific complications of this operation

• Damage to internal organs when placing instruments into the abdomen. This is rare (risk: 1 in 1,000). The risk is higher in patients who have previously had surgery to the abdomen. If an injury does occur, open surgery may be needed, which involves a much bigger cut. About 1 in 3 of these injuries are not apparent until after the surgery, so if you have pain, which does not improve the day after surgery, you must let your doctor know.
• Developing a hernia near one of the cuts used to insert the ports (risk: 2 in 10,000). Your surgeon will try to reduce this risk by using small ports (less than 10 millimetres in diameter) where possible or, if larger ports are used, using deeper stitching techniques to close the cuts.
• Surgical emphysema (crackling sensation in the skin due to trapped gas), which settles quickly and is not serious.
• Failure to find out what the problem is. If you do have a problem, your surgeon may not be able to find out the cause as it may appear that your Fallopian tubes are blocked but this can occur if the tubes go into a spasm or if the dye spills around the neck of your womb. Your surgeon may recommend further tests.
• Failed procedure, where it is not possible to place the laparoscope inside the abdominal cavity (risk: 1 in 180). If this happens, you may need to stay in overnight for close observation.
• Death (risk 8 in 100,000). The risk may be higher, but this will depend on your age and your general state of health.