Laparoscopy and Laparoscopic Surgery
What is the test?
A laparoscope is a flexible tube. The far end of the tube is placed inside the abdomen through a small incision, with the near end remaining outside the body. At the far end of the tube is a light, and a camera that sends a picture to a television screen. The surgeon can perform surgery by controlling surgical instruments. Laparoscopy involves just looking, and laparoscopic surgery obviously involves also doing surgery.
Although x-rays and other imaging techniques have made it possible to see the inside of the body without cutting the skin, these techniques cannot always see what can be seen through a laparoscope. So laparoscopy can help diagnose many conditions.
Surgery of the abdomen and pelvis used to require a relatively large incision. Increasingly popular since the 1980s, laparoscopic surgery allows much smaller incisions. For example, abdominal and pelvic laparoscopic surgery can diagnose and treat infertility or pelvic pain, remove the gallbladder or appendix, and perform tubal ligation to prevent pregnancies.
The main advantages of laparoscopic surgery are reduced pain, smaller scars, a faster recovery time, and a reduced risk of serious bleeding.
How do I prepare for the test?
Discuss the specific procedures planned during your laparoscopy ahead of time with your doctor. Laparoscopy is done by either a surgeon or a gynecologist-obstetrician. You will need to sign a consent form giving your doctor permission to perform this test.
If you take aspirin, nonsteroidal anti-inflammatory drugs, vitamin E or other medicines that affect blood clotting, talk with your doctor. It may be necessary to stop or adjust the dose of these medicines before your test.
You will be told not to eat anything for at least eight hours before the surgery. An empty stomach will help prevent the nausea that can be a side effect of anesthesia medicines. You should arrange for a ride home from the hospital if your doctor plans on sending you home on the same day.
Before the surgery (sometimes on the same day), you will meet with an anesthesiologist to go over your medical history (including medicines and allergies) and to discuss the anesthesia.
What happens when the test is performed?
Laparoscopy is done in an operating room. You wear a hospital gown. You have an IV (intravenous) line placed in your arm so that you can receive medicines through it.
You have general anesthesia for this test, which puts you to sleep so you are unconscious during the procedure. For general anesthesia, you breathe a mixture of gases through a mask. After the anesthetic takes effect, a tube may be put down your throat to help you breathe.
During laparoscopy, the laparoscope is inserted through a very small incision (less than an inch long), usually in or just below your navel. A gas such as carbon dioxide or nitrous oxide is pumped into your abdomen to help lift your abdominal wall off of your pelvic and abdominal organs so that the camera can view them clearly. If you are having any procedure more complicated than inspection of the pelvis or abdomen, your doctor makes one or more additional small incisions to allow other instruments to reach into your abdomen. For pelvic surgeries, it is common for the additional incision to be just below the pubic hair line. You should ask your surgeon where you might expect to have incisions as part of your laparoscopy.
A wide variety of instruments are useful in laparoscopy. These include instruments that can cut and place clips onto internal structures, burn away scar tissue or painful areas in the pelvis, or remove small biopsy samples or even whole internal organs (often in pieces so that larger incisions are not necessary). Your doctor can see the work he or she is doing by watching a television screen.
At the end of the surgery, the instruments are withdrawn, the gas is removed, and the incisions are stitched closed. Your anesthesia is stopped so that you can wake up within a few minutes after your laparoscopy is finished.
What risks are there from the test?
It is easier for patients to recover from laparoscopy compared with regular abdominal surgery (often called "open" surgery) because the wounds from the incisions are so small. You will have a small straight scar (less than an inch long) wherever the instruments were inserted.
Sometimes a small amount of the gas used to expand the abdomen will remain after the surgery for a day or two, before it dissolves away. This can cause some shoulder pain. Depending on the type of operation your laparoscopy involved, you might also have some cramping in the pelvis or abdomen. Some laparoscopy procedures in the pelvis normally cause a small amount of bleeding through the vagina. Some patients experience some nausea from the medicines used for anesthesia or anxiety.
General anesthesia is safe for most patients, but it is estimated to result in major or minor complications in 3%-10% of people having surgery of all types. These complications are mostly heart and lung problems and infections. For laparoscopy, the risk of complications from anesthesia are smaller than average, because most surgeries done with laparoscopy are fairly simple and do not require you to have anesthesia for much longer than an hour.
Must I do anything special after the test is over?
You will be watched for a few hours after your surgery to make sure that you are recovering well. You may be asked to sit up and drink liquids. For many laparoscopic procedures, you can go home the same day. You should not drive or drink alcohol the day of your test.
You should contact your doctor if you develop a fever over 101° F, strong pain, or bleeding from the vagina that is heavier than expected.
You will have a follow-up visit with your doctor to remove stitches if needed and to make sure you are recovering well.
How long is it before the result of the test is known?
If your laparoscopy was done to look for a cause of pain or other diagnosis, your doctor can tell you right after the surgery what was seen during the test. If a biopsy sample is removed, you may have to wait several days for the report.