Laparoscopy

Reviewed by Dr Philip Owen, consultant obstetrician and gynaecologist

What is laparoscopy?

Radiological (X-ray) and ultrasound examinations are able to diagnose many conditions within the abdomen and pelvis but do have their limitations.

Under certain circumstances a clearer picture of the appearance of the abdomen and pelvis is required.

A laparoscopy enables the surgeon or gynaecologist to directly view the organs of the abdomen and pelvis.

How is a laparoscopy performed?

The laparoscope is a sterile surgical instrument that has special optics that allow small amounts of light to be transmitted effectively.

Carbon dioxide gas is pumped through a channel in the laparoscope into the abdomen. This creates a space within which the surgeon can look or operate.

A laparoscopy is performed under a general anaesthetic. A small cut measuring 1 to 2cm is made in or just below the belly-button. Through this cut, the laparoscope is gently introduced into the abdomen.

Additional instruments are often required. These are usually introduced via even smaller cuts in the skin above or to the side of the pubic hair.

What can a laparoscopy be used for?

Most laparoscopies are performed as part of the investigation of abdominal or pelvic pain. The most common illnesses diagnosed through laparoscopy are endometriosis, pelvic inflammatory disease, ectopic pregnancy, ovarian cysts and appendicitis.

In many cases it is possible to perform operations through the laparoscope itself. Most sterilisations today are performed through a laparoscope.

Cysts on the ovaries can be punctured and opened, while adhesions caused by ovarian diseases or other diseases of the pelvic organs can also be loosened.

Most ectopic pregnancies can be treated laparoscopically as can many cases of endometriosis.

Laparoscopic surgery is becoming increasingly popular with patients because the scars are smaller and their period of recovery is shorter.

Laparoscopic surgery requires special training of the surgeon or gynaecologist and the theatre nursing staff. The equipment is often expensive and not available in all hospitals.

How does the patient feel after a laparoscopy?

There is usually pain around the cuts in the skin and often a sense of general discomfort over the abdomen. Many patients report pain at their shoulder tip, which is due to the indirect effect of small amounts of carbon dioxide remaining in the abdomen. Pain relief is always given.

Most patients are fully recovered within 48 to 72 hours.

What are the risks associated with laparoscopy?

There is no such thing as a totally risk-free investigation or operation.

The risk of the general anaesthetic is extremely low if the patient is in good general health.

The risks of laparoscopy include accidental damage to the bowel or blood vessels within the abdomen or pelvis. These complications affect between one to two people per thousand cases and require immediate further surgery to correct any damage.

Minor complications include bleeding or bruising around the skin cuts or bruising of the skin at the front of the abdomen.

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