Laparoscopy

What is a Laparoscopy?

“Laparoscopy” is an outpatient surgical procedure that allows your doctor to look inside your abdomen and pelvis. This is accomplished by placing a small telescope through the lower part of your belly button. You will be completely asleep for this procedure. Anesthesia is administered by an anesthesiologist who will monitor your vital signs. A small tube is placed in your throat and connected to a breathing machine (ventilator) to help you breath while under anesthesia. Carbon dioxide gas is infused into the abdomen to lift the abdominal wall up and away from the internal organs. Most of this gas is removed after the procedure and any remaining gas is absorbed and exhaled. The laparoscope is attached to a video camera to project a picture of the surgery on a TV monitor. Usually from 1 to 3 small (quarter inch) incisions are needed in the lower abdomen, through which small instruments such as graspers and scissors can be placed to do the surgery. Often a laser beam can be used to precisely cut or cauterized tissue if necessary. A large number of procedures can be performed laparoscopically. Most commonly it is used to inspect the pelvic organs (diagnostic laparoscopy), and often to perform surgical procedures (operative laparoscopy) at the same time. Laparoscopy can be used to remove or destroy endometriosis, adhesions (scar tissue), cysts of the ovaries or tubes, tubal (ectopic) pregnancies, or uterine fibroids. It is also used to inspect the fallopian tubes to see if they are open by passing blue dye through the uterus and out the tubes, and to fix or remove damaged tubes.

What can I expect before and after surgery?

A sample of what your doctor may see during your laparoscopy procedure. You should have nothing to eat or drink after midnight before the surgery. If you have medicines that you have to take in the morning, you can usually do this with a small sip of water, but please discuss this with your doctor. You will need to be at the surgery center at the designated time. You should wear loose fitting clothing. Your doctor will meet with you before the surgery to discuss any last minute questions. You will go to the operating room and the anesthesiologist will put you to sleep. You will wake up in the recovery room and feel “groggy” and you will have some abdominal discomfort (gas-like pains). You may also have a sore throat from irritation from the breathing tube. A sore throat lozenge or spray can help with this. You will be observed by the recovery room nurses until you are awake enough to walk on your own, can drink liquids without vomiting, and are able to urinate. The recovery room nurse will tell you when you can go home. Your doctor will have explained the surgical findings with a designated family member while you are waking up. Often, a picture from the surgery will be given to your family member. It is best to fully discuss the findings with you at a later date because the anesthesia will make you forget the conversation in the recovery room. A post-operative check-up and examination should be scheduled for 2 to 3 weeks after surgery, at which time the surgery will be discussed and a plan made for any future therapy.

Recovery

Every patient is different in this regard. While some patients feel able to resume their usual activities in 1 to 2 days, others may take up to a week. On average you should be able to be “up and around” the next day with some abdominal soreness, and back to your usual activities within 2 to 4 days. You may notice gas pains, mild shortness of breath or shoulder pain from the carbon dioxide gas in the abdomen. This discomfort should resolve in 1 to 2 days. You may have some irritation when urinating because the bladder may have been catheterized to remove urine during the surgery. Mild bruising may occur in the lower abdomen. Your belly button may be sore and red and may even leak a small amount of fluid for several days. Oozing from the belly button can be controlled with slight pressure over the area for a few minutes. You can remove your bandages after 2 days, but should not put anything in your belly button. Warm soapy water running down and over the belly button in a shower is sufficient to keep it clean. The sutures used to close the incisions will dissolve and therefore do not need to be removed. You should take ibuprofen 600 mg every 6 hours for 2 days after surgery, and take a narcotic pain pill such as Percocet every 6 hours as necessary for additional pain relief. You may also have vaginal bleeding, but it should be less than a period. You may resume your usual activities and diet when you feel ready, and may resume intercourse one week after surgery.

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Are there any potential complications?

Fortunately serious complications from laparoscopy are rare. The possible complications include bleeding, infection, damage to internal organs and nerve injury. Serious bleeding (hemorrhage) could occur if a major blood vessel is injured and may require a blood transfusion. Injury to the blood vessels, bowel, bladder or ureters (tubes connecting the kidneys to the bladder) may necessitate a laparotomy (an incision to open the abdomen) and other surgical procedures to repair the injury. These complications occur in 1/1000 procedures and are more likely if there is extensive scarring between internal organs or in patients at the extremes of body weight. Other rare complications could include blood clots in the abdominal wall or blood vessels, pelvic organ infections, allergic reactions, damage to nerves in the arms or legs and anesthesia complications. Infection of the belly button after laparoscopy can occur up to 1% of the time and is easily treated with oral antibiotics. You should call the office if you are concerned about any problems especially severe abdominal pain, nausea or vomiting, heavy vaginal bleeding (more than a period), a temperature greater than 101 degrees F or expanding redness or pus from the belly button.

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