Advanced Gynaecological Surgery Centre Endometriosis Laparoscopic Surgery North Adelaide SA
Your doctor has recommended laparoscopic (keyhole) surgery to treat your medical condition. This type of surgery will require a general anaesthetic.
Laparoscopy may be done to find a cause or symptom that cannot be diagnosed by ordinary questioning and examination. A laparoscopy may be recommended if you have: Pelvic pain Infertility Suspected ovarian cysts Suspected ectopic pregnancy Endometriosis
Laparoscopy may also be used in performing operations such as: Tubal sterilisation or reversal Hysterectomy Treatment of incontinence or prolapse Removal of fibroids The Procedure
Laparoscopic gynaecological surgery is performed through 2 to 4 small incisions in your abdominal wall. The camera (telescope) is usually placed through a hole just below your umbilicus (belly button) and the instruments are passed through the other small incisions in order to perform the surgery. Carbon dioxide gas is used to distend the abdomen to allow visualization of the internal organs.
Once your abdomen is inflated, the doctor will place a tiny telescope (called a laparoscope) through the cut. The laparoscope has a video attached so the doctor can clearly see inside. Other instruments are also used to gently move the pelvic organs and allow the doctor a better view. You will notice after the operation that you have several small cuts on your abdomen which is where other instruments have been used. An instrument is also put through the vagina and into the uterus so the doctor can move your uterus.
At the end of the operation, all the instruments that were used in the operation are removed, the gas is let out and the skin cuts are closed stitches. These may need removing any time from 3 – 7 days after the operation by a Practice Nurse in the Doctor's rooms. Risks
Laparoscopic surgery in healthy women is generally held to be safe but the risks will depend on the nature of the surgery to be performed as well as your general health. The risk of a major complication occurring is around 1 per 1000 with a diagnostic laparoscopy and 8 per 1000 with an operative laparoscopy.
During the operation major complications include: Injury to internal organs – e.g. bowel / ureter or bladder. Haemorrhage requiring a blood transfusion. Gas embolism. The carbon dioxide gas used to distend the abdomen may, rarely, pass into the large blood vessels up to the lungs, causing problems with the lungs and heart.
Following the operation problems include: Wound, pelvic, bladder or chest infection (1-5%) Pelvis or wound haematoma (collection of blood clot) DVT – deep vein thrombosis (blood clot in the leg veins) Pulmonary embolus (blood clot in the lungs) – rare but serious Abnormal wound healing / scar formations (keloid) Constipation (very common) Shoulder pain/discomfort Wound pain
During any laparoscopic operation there is a chance that the surgeon may need to convert to open surgery in order to complete the procedure safely. The chance of this happening will also depend on the complexity of the surgery being performed. The above list is not exhaustive and does not include all possible risks. If you have any further concerns please feel free to ask your specialist. Your surgeon will discuss these risks with you prior to obtaining your consent. What to expect after laparoscopic surgery Hospital Stay Day surgery for very minor procedures. More complex procedures such as excision of endometriosis, removal of an ovary etc usually require about 1-2 nights stay.. Return to work / normal activities Between 1-2 weeks for most laparoscopic surgery. You should not drive a car for at least 3 days after surgery.
For more detail of what to expect after laparoscopic surgery please refer to the separate handout covering this topic. What to expect after laparoscopic surgery Following your surgery you may experience: some degree of nausea discomfort and tiredness is common for up to five days pain where the cuts were made abdominal bloating for up to 2-3 weeks aching of the muscles pain in the shoulder tip and rib cage. This is due to small amounts of gas remaining under the diaphragm there may also be period type pains and a few days of vaginal bleeding or discharge. constipation Pain relief Pain relief tablets such as regular paracetamol, capadex or non steroidal anti-inflammatory medications (i.e nurofen) may be required for at least 5-7 days following a laparoscopy but possibly up to 4 weeks or more in some instances. Try and avoid codeine containing painkillers where possible as they cause constipation. Shoulder tip pain Shoulder discomfort is common after a laparoscopy due to some residual carbon dioxide gas in the upper abdomen irritating the nerves near your diaphragm muscle. This is normal (and not dangerous) and usually settles in less than 1 week as your body reabsorbs the CO2. It may be improved by local heat (heatbags placed over affected area), pain relief and can be positional so try different positions (i.e lying on your side, reclining on 2-3 pillows etc). Wound care: You will have 2-5 dressings covering the small wounds. These may be left in place until they become discoloured or start to peel off. Dry them off after your shower by wiping with a towel or using a hair dryer (on cool setting). Avoid having baths or getting into a spa until after your stitches have been removed and any vaginal bleeding has stopped. Resumption of daily activities: First week No housework such as washing, ironing, cleaning and gardening Rest as much as possible with frequent short walks around the house Within 1-2 weeks Activities such as driving, simple chores and non-vigorous exercise (eg; walking, bike riding, Tai Chi) may be resumed if you feel comfortable Driving can be resumed at your discretion but usually not before 3-7 days Return to paid employment Within 3-4 weeks Vigorous exercise (eg: competitive sport) may be resumed after 3-4 weeks depending on the extent of your surgery and how you feel. If any activity causes significant pain or discomfort avoid that activity until you are feeling better. Sexual intercourse - it is best to wait between 10-14 days for a minor laparoscopy and 3-4 weeks from an operative laparoscopy (i.e. removal of endometriosis, removal of ovary or cyst etc) and all bleeding or vaginal discharge has settled or until after your post operative visit. Vaginal bleeding or discharge Most women will have some vaginal bleeding or discharge that is blood stained or perhaps a brownish colour that will usually settle after 7 days or so following their laparoscopy. Do not use tampons. General advice Everyone recovers at a slightly different rate. Please contact the rooms on Ph (08) 8132-0566 for advice if you develop: severe abdominal pains that do not settle after taking pain relief and rest ongoing vomiting, a high fever ( 38 degrees) very offensive vaginal discharge heavy vaginal bleeding
Click here to download the pdf version of Laparoscopy Information Sheet You will need the Adobe Reader to view and print the above documents.