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Explaining Laparoscopy & Laparoscopic Surgery

Prior to signing a consent form, patients need to be aware that anaesthesia and surgery carry an element of risk, however small.

Laparoscopy is a procedure used to view structures within the pelvis and abdomen. It is usually carried out under general anaesthetic. Following the induction of anaesthesia, the abdominal cavity is inflated with gas to facilitate a good view of the pelvic organs and a telescope introduced through a small incision in the umbilicus (navel). Further small incisions are made under direct vision to insert further instruments to allow for a more detailed inspection of the pelvis, and if necessary to allow operation on various pelvic structures.

All procedures under anaesthesia carry small but inherent risks and you should understand these before agreeing to undergo the procedure:

1. The risks of anaesthesia for elective surgery under modern conditions are very small indeed. Your status will be carefully monitored throughout the operation by a Consultant Anaesthetist. However, there are risks intrinsic in all anaesthesia and if you wish to discuss them please feel free to do so when you meet your anaesthetist before the operation.
2. The insertion of the first instrument is a 'blind' procedure and despite all precautions does, albeit very rarely, result in damage to underlying structures. 

   This can include:

   • Inadvertently placing the needle into a blood vessel causing a carbon dioxide embolus (gas in a blood vessel)

   • Although damage to major blood vessels has been recorded, more common is minor damage to blood vessels that can usually be dealt with using laparoscopic surgical techniques.
   • Damage to the urinary tract - uncommon during diagnostic procedures, but can occasionally happen, particularly if the bladder is full prior to surgery. Repair can usually be effected surgically using laparoscopic techniques.
   • (iv) Bowel damage. This is by far the most common complication although it is still rare and is often associated with adherent underlying bowel, possibly the result of previous surgery. If recognised and dealt with promptly, there are few complications, but difficulties can arise if the damage is not quickly dealt with.

 

Above are two laparoscopic views showing deep deposits of endometriosis - frequently missed without specialist training

Laparoscopic view of pelvis showing large endometrioma

Operative laparoscopy carries an increased risk of bowel, major blood vessel and urinary damage as dissection of these organs is necessary. However, all these procedures are undertaken under direct vision using fine instruments with the appropriate equipment available to deal with any complications. In experienced hands, the complications of operative laparoscopy are no greater than those for 'open' surgery.

All these complications can occur at open surgery as well. You should also be aware that there alternatives to laparoscopic surgery, such as conventional open surgery and, in some cases, treatment with hormones or other pharmaceutical preparations. All treatments carry an element of risk, side effect and drawbacks.

Laparoscopic surgery when performed successfully affords much less post operative discomfort and a faster recovery than conventional surgery. The procedure is often performed as a day case or with one night's post operative stay, although for patients who require laparoscopic bowel surgery a stay of two or three days may be necessary.

Laparoscopic surgery requires the use of various instruments and energy sources and dissection when it is used may either be blunt, which involves gently teasing tissues apart, or sharp, using diathermy, laser or scissors to make incisions. Diathermy, an electric current, may be used both to divide tissues or to coagulate tissue, particularly blood vessels to control any bleeding. Light energy in the form of lasers may also be used, both to ablate tissue and as a cutting tool. The advantage of laser surgery is that the effect of the laser is very precise and reduces tissue damage to a minimum.

Laparoscopic excision of large endometrioma

Histological result showing typical nodular endometriosis

Histological result showing typical colonic endometriosis

The wound should be dried (if tender a hair dryer is a good way to do this). It should then be left open, unless, if it is uncomfortable next to clothing or if moist, a dry non-occlusive dressing such as gauze should be placed over it.

It is very common to expect some pain after the procedure. Shoulder pain may occur as a result of distending the abdomen with gas. As the gas absorbs into the blood stream and is exhaled through the lungs the pain will gradually disappear, usually over 24 or 48 hours. Depending on the surgery carried out there may be some interference in bowel function leading to abdominal distension and colicky discomfort.

Some difficulty may be experienced in passing urine after the operation. This is because it is usual to empty the bladder by passing a catheter during the procedure. If you experience symptoms of cystitis, namely: passing urine frequently with burning discomfort, try drinking copious amounts of fluid to "flush" through the urine. If your symptoms persist your urine should be tested for infection, and if necessary, the appropriate antibiotics prescribed.

You may expect some vaginal bleeding from time to time for anything up to 2 weeks after your operation. This is usually due to manipulation of the ovaries. If the bleeding becomes excessive you should seek medical help.

In the first post-operative day you should rest in bed and take limited activity. After this you may resume normal activities although you should not undertake any strenuous physical exercise or heavy lifting. You should refrain from sexual intercourse for about 10 days after the operation