Laparoscopy

DEFINITION

The laparoscopy is essentially a telescope, which is inserted into abdominal cavity after it has been inflated with carbon-dioxide. The direct view obtained allows the diagnosis of gynaecological disorders and surgery without laparotomy.

TECHNIQUE

The procedure is almost invariably performed under general anaesthesia with the patient paralyzed and ventilated. The patient is placed in the modified Lloyd-Davies position with the head down. The bladder is catheterized. A small incision is made at the umbilicus and a Verres needle is inserted into the peritoneal cavity. Carbon dioxide is inflated into the peritoneal cavity. The needle is withdrawn and the laparoscopic trocar and cannula inserted. The trocar is withdrawn and replaced with the laparoscopy which allows direct visualization of the pelvic organs If needed, further cannulae are inserted under direct laparoscopic vision, suprapubically or in either iliac fossa, to permit manipulation of pelvic organs and instrumentation for various surgical techniques.

INDICATION

These include pelvic pain, exclusion and treatment of ectopic pregnancy , infertility, sterilization, trauma, lost IUCD and assisted conception techniques, as well as staging procedures for Gynaecological cancer, including pelvic lymph node sampling. Operative laparoscopy now has many applications, for example the treatment of endometriosis either by laser ablation or diathermy excision, removal of benign ovarian cysts, removal of ovaries at vaginal hysterectomy and treatment of ectopic pregnancy .

DISCUSS THE BENEFIRTS OF LAPAROSCOPY OVER LAPAROTOMY WITH YOU CAREGIVER.
REASONS FOR PROCEDURE

  • Evaluation and treatment of infertility in women.
  • Evaluation of known or suspected endometriosis.
  • Complications from pelvic disease.
  • Masses or cysts in the pelvis.
  • Undiagnosed pelvic pain.
  • Fibroid tumors of the uterus.
  • Voluntary sterilization.
  • For diagnosis and treatment of a variety of abdominal disorders.

RISK INCREASES WITH

  • Obesity.
  • Smoking.
  • Heart or lung disease.
  • Advanced pregnancy.
  • Previous abdominal surgery, especially hernias.
  • Previous bowel surgery.
  • Use of mind-altering drugs.

DESCRIPTION OF PROCEDURE

  • It is performed in an outpatient surgical facility or hospital.
  • General anesthetic is administered by injection and inhalation with an airway tube placed in the windpipe (a local anesthetic is used sometimes).
  • It is often necessary to place an instrument (tenaculum) on the cervix in order to help move the uterus around.
  • A small incision is made in or below the patient’s navel. A needle is inserted to inflate the abdomen with carbon dioxide.
  • The operating table is tilted to allow the bowel and carbon dioxide to float up toward the chest. The laparoscope is used to examine the abdomen visually.
  • The laparoscope is used to perform surgeries, if necessary – gallbladder removal, diagnosis and treatment of ectopic pregnancy, tubal ligation, aspiration and excision of ovarian cyst, and multiple other gynecological procedures.
  • The laparoscope is removed, and carbon dioxide is allowed to escape from the abdomen.
  • Small sutures under the skin and an adhesive bandage are used to close the wound. In some cases, a long-acting local anesthetic can be injected into the wound for pain relief.

EXPECTED OUTCOME

Expect full recovery without complications. You may experience slight discomfort for 24 to 48 hours. You may have aches in your shoulders and chest from the carbon dioxide that was used to inflate your abdomen. No treatment is necessary. Allow 6 days for full recovery from surgery.

POSSIBLE COMPLICATIONS

Perforation of the intra-abdominal organs (bowel, bladder or liver) and intra-abdominal blood vessels.

POSTPROCEDURE CARE
GENERAL MEASURES

  • Change the adhesive bandage daily.
  • Bathe and shower as usual. You may wash the incision gently with mild soap.
  • If the procedure was for sterilization and you were taking birth-control pills, finish your present package; then you no longer need birth-control methods.
  • Use sanitary pad (not tampons) to stop slight vaginal bleeding, which may occur after surgery.
  • Sit in a warm tub of water for 10 to 15 minutes at a time to relieve discomfort.

ACTIVITY

  • To help recovery and aid your well-being, resume daily activities, including work, as soon as you are able.
  • Resume driving 24 hours after recovery from surgery.
  • Sexual relations may be resumed in 2 or 3 days after recovery from surgery.