Laparoscopic Surgery

What is laparoscopy?

Laparoscopy or keyhole surgery is a type of operation in which doctors use a viewing telescope (laparoscope) to look at the organs inside the abdomen and the pelvis. With the aid of powerful light source, camera and video monitors, the image is magnified many times larger than real life. This helps doctors find out the causes for abdominal or pelvic pain, the reasons behind infertility, or the nature of abnormal growths or mass. This is called diagnostic laparoscopy.

What is operative laparoscopy?

Over the last decade, major advances in laparoscopic surgery have made it possible for many conditions to be treated via laparoscopy.
In pelvic surgery, some of these conditions include:

  • Hysterectomy
  • Endometriosis
  • Ovarian cysts
  • Fibroids
  • Pelvic organ prolapse
  • Urinary incontinence
  • Repair of tubal damage
  • Division of adhesions
  • Pelvic infection
  • Certain types of cancer
What are the benefits of laparoscopic surgery compared to open surgery?

Compared to open surgery, laparoscopic surgery offers many benefits which include small skin incisions, better cosmetic scars, less postoperative pain, shorter hospital stay (often day-only), faster recovery and earlier resumption of normal activities and employment.

What are the risks or complications with laparoscopic surgery?

The adage that no surgery is without risk also applies to laparoscopic surgery. In general, the risks associated with diagnostic laparoscopy are less common than with operative laparoscopy. The risks are in turn related to the extent of the underlying problems (severe diseases most likely mean higher risks) and the expertise / experience of the treating surgeon.

While it is not practical for your doctor to mention every possible complication of surgery, the following list covers the main potential risks and complications associated with any form of surgery:

  • Risks associated with general anesthesia: intubation difficulties, drug allergy, heart problems, lung infection.
  • Wound infection - treatment may require antibiotics and drainage.
  • Bleeding: at entry wound or at the site of surgery
  • Blood transfusion - if bleeding is severe and life-threatening, blood transfusion may be required. If you are against blood transfusion, you must make this clear in writing to the surgeon and anaesthetist and nursing staff before consenting for surgery.
  • Incisional hernia - portion of the internal fat layer or bowel may protrude through the weakened abdominal wall at the site of the surgical wound. Surgery may be required to correct this.
  • Keloid or painful scar
  • Blood clots in leg veins (thrombosis) with possible clots to the lungs (pulmonary embolism)
Some potential risks and complications are specific to laparoscopic surgery.
  • Injury to abdominal wall blood vessels may result in haematoma for which surgery to secure the bleeding or drainage may be required.
  • Port site hernia may require surgery for treatment.
  • Injury to internal abdominal and pelvic organs: bowels, bladder, ureter, blood vessels. This may occur during surgery or may present some time after surgery. These complications may mean further surgery for correction of the injury. In the case of the bladder or ureter, this may mean the use of urinary catheter. In the case of bowel injury, this may result in leakage of bowel contents, peritonitis, septicaemia. Corrective surgery for bowel leakage may require the use of diversion of bowel contents to external bag (ileostomy or colostomy), and re-operation.
  • Conversion to open surgery (laparotomy) in case of unexpected life-threatening complications or findings such as malignancy.
What kind of anaesthesia is required for laparoscopic surgery?

With few exceptions, laparoscopic surgery is only carried out under general anesthesia.

What happens in a diagnostic laparoscopy?

Once general anaesthesia is administered, the doctor makes a small incision at the base of the umbilicus through which the laparoscope is inserted into the abdomen. The abdomen is then inflated with gas. This helps to expand the abdominal cavity making it possible to see the abdominal and pelvic organs clearly. Sometimes another small incision is required to allow the doctor to hold and thoroughly inspect the various organs.

What happens in an operative laparoscopy?

In operative laparoscopy, doctors set out to remove disease, for example a cyst or endometriosis, or to repair a damaged organ such as a blocked tube. This generally requires doctors to make two or more small incisions to carry out the operation.

What to do before the laparoscopy?
  • Discuss with your doctor any concern you have before surgery. Ensure that you understand clearly the indication for the recommended treatment.
  • Take time to discuss and consider the risks and benefits of the recommended procedure and to understand what is going to be done.
  • Feel free to seek another opinion if you are unclear or uncertain about the explanation or advice you have been given.
  • Ensure all paperwork and admission forms are in order.
  • Check with the hospital to find out when to begin fasting and when to come into hospital. In general, fast for six hours before surgery as laparoscopy requires that you have a general anesthesia.
  • Clean the umbilicus with cotton buds, soap and water the evening before surgery to reduce the risk of wound infection.
What to expect following laparoscopy?
  • Your length of hospital stay depends upon the type of laparoscopic surgery you undergo. For diagnostic laparoscopy, you almost always can go home on the same day. For operative laparoscopy, you may remain in hospital for one to four days, depending on the type and extent of your surgery.
  • You may have a light diet, unless your surgeon states otherwise.
  • We encourage that you take a few short walks every day to prevent blood clots forming in your legs.
  • A catheter in your bladder will be removed when instructed by your surgeon.
  • Mild laxatives may be required to prevent constipation.
Wound Care

The laparoscopic sites will have stitches that dissolve and be covered with small paper tapes (Steristrips). The waterproof dressings are to be removed two days after your operation. Keep the sites clean and dry. You may remove the Steristrips after 5-6 days.

Post-operative Symptoms
  • Expect some soreness and pain around the incision sites for several days.
  • You may also experience some shoulder tip or rib cage pain. This is due to a small amount of residual gas under the diaphragm. Peppermint tea, Panadol and a hot pack applied for a short time to the painful area may be helpful. Anti-inflammatory medication may be required.
  • Some degree of abdominal bloating is normal and will settle over the next few days.
  • You may have vaginal bleeding and spotting or discharge for up to six weeks following surgery. Sanitary pads are to be used, not tampons.
Activities
  • Increase your physical activities gradually over the next few weeks.
  • Avoid vigorous activities for the first weeks after your operation. Avoid exercises such as sit-ups or lifting heavy objects until after your first post-operative review.
  • You may resume sexual intercourse six weeks following surgery unless your doctor states otherwise.
  • Avoid driving a car for up to two weeks, or until you are not suffering any affects from strong pain relievers and feel comfortable to drive. If you have any concerns, check with your insurance company for their guidelines.
  • You may need one to two weeks off work. This varies depending on your work activities and the type of surgery performed.
Follow-up appointment

You will be advised of the follow-up appointment time prior to hospital discharge. This is generally within 4-6 weeks after surgery.

What to look out for after discharge from hospital.

In general, normal recovery means you should feel gradually better each day. Notify your surgeon, if you notice any of the following:

  • Fever (greater than 38°)
  • Increasing abdominal pain
  • Nausea and vomiting
  • Increasing or heavy vaginal bleeding
  • Increasing tenderness and redness at the wound sites
  • Increasing unwell feeling

If you are unable to contact your surgeon, try contact your family doctor or the hospital where you had your surgery, or the nearest hospital emergency department and ask the doctors there to contact the treating surgeon.