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Laparoscopy

A look in the abdominal cavity

Introduction
The gynaecologist has proposed to carry out a laparoscopy. This is a procedure in which the doctor uses a special instrument known as a laparoscope to look inside the abdominal cavity. The gynaecologist makes one or two small incisions in the abdomen (usually in the navel and the pubic hair area) so that the laparoscope and manipulator can be inserted into the cavity. Laparoscopy may be required to track down the cause of abdominal pain or fertility problems. In some cases, minor abnormalities can be resolved straight away during the procedure. Laparoscopy is also used for sterilisation operations. Furthermore, laparoscopy provides the capability to remove small pieces of tissue for further examination (biopsy) or to perform other simple interventions inside the abdominal cavity.  

What can you expect?
A laparoscopy is a (fairly simple) procedure that takes about half an hour on average. It is generally done as a daycare procedure, so you can go home again the same day. Sometimes the doctor may prefer to admit you to hospital for the day and night. This will be discussed with you beforehand. Laparoscopy is generally done under general anaesthesia. This means that you must not eat or drink anything after midnight the evening before the procedure. Please arrange for transport back home beforehand, because driving or cycling immediately after the procedure is not recommended.




How is the examination done?

After checking in at the hospital at the agreed time, you will be allocated a bed. You will be asked to hang all your clothes in a closet and put on an operation gown. A nurse will take your blood pressure and sometimes you will be given a sedative to reduce anxiety for the procedure. You will be administered a general anaesthetic in the operating theatre. Once you are asleep, the doctor will make a small incision in or directly under the navel. A thin needle with a rounded point is placed in the abdominal cavity. Through this Co² gas is placed inside. This effectively inflates the abdomen a little, making it easier to see inside and thereby reducing the chance of injury to the intestines or blood vessels. Next, a thin telescope with a light source connected to it (the laparoscope) is inserted into the abdominal cavity through the incision. The doctor can now obtain a good view of all the organs in the abdominal cavity. As well as the reproductive organs (uterus, Fallopian tubes and ovaries), this includes the peritoneum, bladder, appendix, liver, gall bladder, and large and small intestines. If necessary, the doctor makes a second incision, in or just above the pubic hair area. Auxiliary instruments can be inserted through this, for example an instrument for pushing the organs aside during the examination, or a special pair of tongs that can be used to remove a small piece of tissue (biopsy). A small rod (cannula) is often placed in the uterus via the vagina, so that the uterus can be moved to get a better view of the pelvic organs. Once the examination is completed, the doctor lets the gas escape and the laparoscope is removed. The wounds are stitched and you are taken to the recovery room.  

What can you expect after the examination?
You will remain in the recovery room until you are completely awake again. Then you are moved back to your room, where you will remain until you can go home. For the first 24 hours, you may experience some discomfort in or around your shoulders. This happens because a small amount of gas may remain in the abdominal cavity. This remaining gas is absorbed into the bloodstream fairly rapidly and then exhaled via the lungs. Some patients feel a bit under the weather for the first few days after the examination. This is a side-effect of the narcosis, which will disappear by itself. You may also experience a little abdominal pain for a couple of days. Sometimes there is blood loss from the vagina. The incisions usually will heal within a week. Depending on the sort of stitches they will have to be removed within one week or they will dissolve by themselves. In some cases, there will be a check-up a little while after the examination; the doctor will discuss the results of the examination and/or the treatment with you after the operation and/or during the check-up visit. The incisions leave very small scars that become practically invisible in the course of time.  

It is a good idea to take it easy for a number of days. If you are unsure about anything, ask what you may and may not do before you leave the hospital. Naturally, the point at which you are able to function again normally will depend on the nature of the procedure (examination only, or treatment as well, and if so, which). You will be able to tell yourself when you can do everything normally again. 

Can complications occur?
Contact your doctor if one or more of the following occurs:

  • abdominal pain that worsens instead of it diminishing
  • fever
  • redness and/or swelling around the incision
  • fluid coming from the incision  

Outline of indications for a laparoscopy
The organs of the abdominal cavity are examined during a laparoscopy. Simple procedures, such as the removal of small growths, sterilisation and biopsies can be performed during this operation. The causes of various complaints can sometimes be traced, and treated if possible. In other cases, a laparoscopy can be used to determine whether another, more major operation, is required.  

Sterilisation
Closing off the Fallopian tubes is often done by laparoscopically. The Fallopian tubes are closed with a small ring or clamp, or a piece is removed from each of the tubes. Ovum and sperm can no longer reach each other, so pregnancy can no longer occur.  

Abdominal pain
Laparoscopy can be performed for complaints involving persistent abdominal pain. There is a wide range of causes of abdominal pain, and it can not always be found out with a laparoscopy. Possible causes are:

  • endometriosis
  • inflammation
  • adhesions
  • internal bleeding  

Infertility
In examinations for infertility laparoscopy can be used to help track down abnormalities that would not be (sufficiently) visible using other methods of investigation. These abnormalities include growths, adhesions, endometriosis, or (partially) blocked Fallopian tube. To evaluate the ratency of the Fallopian tubes, a blue dye is injected via the cervix. If the Fallopian tubes are open, the dye will be seen in the abdominal cavity. The laparoscopy is performed in the second week of the cycle, i.e. between the last menstruation and the anticipated ovulation.  

Endometriosis
The mucous membrane of the uterus, known as the endometrium in medical terms, can also appear in the abdominal cavity, outside the uterus. This is called endometriosis. During menstruation, these areas of the uteral mucous membrane also bleed and can cause pain. Laparoscopy can be used to determine where the endometriosis is. This can be removed or treated after the operation with medication.  

Inflammation
When the Fallopian tubes are inflamed, laparoscopy can be used to see how severe the inflammation is. It is also possible to obtain a culture swab for bacteriological examination if necessary.  

Adhesions
Inflammations or operations can cause scar tissue to form inside the abdomen. This can cause adhesions of the organs, which can be very painful. Some adhesions can be separated during a laparoscopy using a special pair of scissors.  

Internal bleeding
Some illness or an accident can cause bleeding from one of the abdominal organs. Laparoscopy can be used to determine where the blood is coming from. Internal haemorrhages are very painful, not only because an organ has been damaged but also because the accumulation of blood can cause a great deal of pain. During a laparoscopy, the excess blood can be removed.  

Disorders of other abdominal organs
Laparoscopy is used in gynaecological examinations, but can also be very useful in helping to establish disorders of other abdominal organs.  

Enlargement of the ovaries
An ovary can become enlarged due to a cyst (a cavity filled with fluid) or a tumour. If there is a cyst, the fluid can be drained and the cyst removed. If it proves to be a growth, then a piece of tissue or the whole area can be removed for further examination.  

Enlargement of the Fallopian tubes
A Fallopian tube can also become blocked due to an accumulation of fluid. This can be established during laparoscopy. If there are fertility problems, it is also possible to see whether the Fallopian tube can be repaired by an operation.  

Fibroids (Myomas)
Fibroids can occur near or on the wall of the uterus. They consist of muscle and connective tissue, and vary in size. Depending on exactly where they are located, they may cause pain and/or infertility and/or increased menstrual loss.  

Obtaining ova
Laparoscopy is still used in some cases to extract ova for in vitro fertilisation but this is generally done via the vagina.

If you have any further questions after reading this information, please contact the Gynaecology secretarial office, tel. +31(0)70 - 312 46 90.