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Operations associated with functional gynaecology


Laparoscopy

Gynaecologists can look inside the abdomen during the procedure. The objective is to inspect the internal organs. This procedure can greatly help in diagnosing certain conditions and can be used to treat conditions like scar tissue, endometriosis and ovarian cysts. This operation is often called minimal access surgery, keyhole surgery, or ‘endoscopy’, which means ‘to look inside’. You may hear your gynaecologist use these terms. Thin telescopic instruments called endoscopes are used in laparoscopy. A video camera is fitted to the endoscope so the gynaecologist and surgical team can view the images on a video monitor.

In laparoscopy the endoscope is inserted in to the abdomen through a small cut in the abdomen or navel.  Sometimes a small piece of tissue (biopsy) is taken for further analysis. Surgery to treat many gynaecological conditions is performed safely and effectively during laparoscopy. Compared to laparotomy (surgery through a larger incision in the abdomen), laparoscopy has significant benefits, which include:

  • smaller less visible scars
  • less pain and discomfort during recovery
  • Usually quicker recovery after surgery and an earlier return to daily activities

Length of stay: It is generally performed as a day only procedure but 1/40 patients have to stay overnight.

The procedure: A thin hollow needle is inserted in to abdomen (usually through a small cut in the navel), and carbon dioxide gas is passed into the abdominal cavity. The gas gently inflates the abdomen, raising the abdominal wall above the uterus, bowel and other organs so they can easily be inspected. The bladder will be emptied with a urinary catheter placed in the urethra temporarily.

The laparoscope is then inserted. If necessary, special instruments may be inserted through 1 to 3 incisions, usually near the pubic hairline. The gynaecologist uses these instruments to move the pelvic organs to get a clear view of the area. The instruments may also be used to perform surgical treatment, as discussed with your gynaecologist. An instrument is usually placed in the uterus through the vagina, so pelvic organs can be manipulated during the procedure.

When the instruments are removed, the carbon dioxide gas is released from the abdominal cavity. A stitch may be used to close each of the small cuts.

Conversion to open surgery (laparotomy): in some cases, the gynaecologist may find that is not safe to continue the laparoscopy due to unexpected or life threatening problems. The gynaecologist may have to continue treatment through laparotomy, which is open surgery through a larger incision in the abdomen

A woman may be disappointed that she has had open surgery instead of laparoscopy, but it is done in the interests of her safety and wellbeing. The decision to convert to open surgery should be considered sound judgement. Before you sign the consent form, it is best to discuss the possibility of open surgery and its benefits

Recovery after laparoscopy: following laparoscopy your recovery will depend on the amount of surgery performed during your procedure. If you have general anaesthetic, do not drive for at least 24 hours and do not make any important decisions for 2 days. Although some women feel able to return to work the next day, others take 1 or 2 days of work. Shower and bathe as normal. Tampons may be used and changed regularly. Expect to remain off work for at least 3 days

After your operation you may experience some symptoms that may last several days:

  • Tiredness
  • Mild nausea
  • Muscle pain
  • Pain or discomfort at the site of the incision
  • Pain in 1 or both shoulders that may extend to your neck. This thought to be caused by the carbon dioxide gas used during the procedure. This pain may last a few days. Lying down often helps improve it
  • Cramps similar to period cramps
  • A little vaginal discharge or bleeding may last a few days
  • A sensation of swelling in the abdomen
Pain relief
Paracetamol is usually sufficient to relieve pain and discomfort. If you need stronger pain relief ask your gynaecologist.

Resumption of normal activities
Normal physical and sexual activities can be resumed once any bleeding and discomfort have disappeared, and you are feeling well enough. Risks
1/500 Bowel injury
1/2000 Vessel injury
1-2% Conversion rate (Laparotomy)
2% Infection
Uterine perforation (rare)
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