Laparoscopy, a minimally invasive procedure utilized for both diagnosis and treatment
Laparoscopy is an outpatient minimally invasive procedure utilized for both diagnosis and treatment of many gynecologic conditions. It involves the placement of a camera instrument into the abdomen. The ultimate goal of the procedure depends upon the condition for which it has been recommended. In some circumstances, laparoscopy is indicated as a diagnostic aid, detecting or confirming certain conditions suspected based on physical exam or radiological studies such as ultrasound, hysterosalpingogram, CT scan, or Magnetic Resonance Imaging. In other situations, laparoscopy is used to treat conditions such as ovarian cysts, uterine fibroids, and adhesions causing pelvic pain or infertility, or to perform permanent tubal sterilization. Additionally, we can use the laparoscope to perform procedures normally accomplished through a large abdominal incision, including hysterectomy or myomectomy (removal of fibroids while leaving the uterus).
This procedure is typically an outpatient procedure (except for hysterectomy or myomectomy), meaning that patients are discharged to home directly from the recovery room when they are deemed “stable”, usually after 1-1 ½ hours. It is performed under general anesthesia, and involves placement of a long cylindrical tube functioning as a camera through an incision in the navel. Additional incisions (less than 1 centimeter long) are made in the lower abdomen in cosmetically appropriate locations. Accessory ports are placed through these incisions so that instruments can be placed and utilized in the surgical procedure.
The following will describe the events leading up to the surgery, as well as the procedure itself so that you will feel more comfortable and less anxious.
HOW IT IS DONE
As mentioned previously, the procedure entails placing a camera port through a small incision in the navel. Two additional small incisions will be made on either side of the abdomen above the pubic bone so that other instruments may also be placed into the abdomen to facilitate the procedure. We use these instruments as we would our hands to dissect through tissue and to cut or cauterize as needed. In this way we are able to thoroughly inspect pelvic organs and perform curative procedures. The procedure may take a short period of time (20 – 30 minutes), such as in diagnostic laparoscopy or for tubal sterilization. If the procedure is complicated, it may take from 1-3 hours. Once the surgery is completed, instruments are removed and the incision sites are sutured closed. Then you will be taken to the recovery room where you will remain for 1-1 ½ hours until being discharged home. If laparoscopy was performed for major procedures, then you will remain in the hospital overnight.
RISKS ASSOCIATED WITH LAPAROSCOPY
As with any medical procedure, there are risks and unforeseen complications. Most patients go through surgery with little difficulty, but problems can happen ranging from trivial to fatal. These include nausea, vomiting, pain, bleeding, infection, poor healing, hernia, or formation of adhesions (scar tissue in the abdomen). Unexpected reactions may occur from any drug or anesthetic given. Unintended injury may occur to other pelvic or abdominal structures such as tubes, ovaries, bladder, ureter (tube from kidney to bladder), or bowel. Such an injury may require immediate or later additional surgery to correct the problem. Dangerous blood clots may form in the legs or lungs. Finally, it is impossible to list every possible undesirable effect and that the condition for which surgery is done is not always cured or significantly improved and in rare cases may be even worse.
ALTERNATIVES TO LAPAROSCOPY
Understand that the decision to undergo laparoscopy is completely up to the patient. You may decline the procedure knowing that care will still be provided for the particular problem. The alternative form of care, whether by use of medications or another form of surgical therapy may or may not produce similar results as the recommended laparoscopy.
PREPARING FOR SURGERY
On the night before surgery, eat a light meal. Do not eat or drink anything after midnight on the day of your surgery if your surgery is in the morning. If it is in the afternoon, don’t eat or drink anything 8 hours prior to the scheduled time of your surgery. If your surgery is going to be extensive, then a ”bowel prep” may be necessary (this entails consuming a liquid designed to cleanse the bowels of all of its contents). If this is necessary, I will discuss this with you. This is usually recommended in cases where endometriosis or severe adhesions are suspected.
THE DAY OF SURGERY
When you arrive at the surgery center (either the outpatient surgery center or main hospital – we’ll tell you exactly which location), you will need to register. At John Muir Medical Center, you may register in the main hospital lobby. Sometimes in the very early morning, the registration area is closed. In this case, walk over to the Emergency Room and register there. If you are having your procedure at Aspen Surgery Center located on the first floor of the new parking structure on the side of John Muir Medical Center, enter through the main entrance and turn left down the hallway. You will see the signs to the registration area on the left. You will then proceed to the “pre-op” area where you will be asked to fill out paperwork, change into a hospital gown, and recline in a hospital gurney. Labs may or may not be drawn, depending on the reason for the D&C and whether or not they were drawn previously. An I.V. line will be placed into a vein in your hand or arm either in the “pre-op” area or the operating room itself.
Next you will be interviewed briefly by your attending nurse and subsequently the anesthesiologist. I will arrive just when we are scheduled to go back to the Operating Room. Feel free to ask any last minute questions at that time. Next, it’s time to head into the Operating Room, where you will notice it to be quite chilly. We will move you from the gurney to the operating table and will cover you with warm blankets. The anesthesiologist will place a blood pressure cuff around an arm, and place EKG electrodes on your chest to continuously monitor your blood pressure and heart rate and rhythm throughout the surgery. At this time the anesthesiologist will then give you a medication through your I.V. that will make you very sleepy and you will then drift off to sleep.
Pain control during the laparoscopic procedure will be controlled by the use of local, regional, or general anesthesia, which you will select in discussion with your anesthesiologist. In general, general anesthesia is preferred because when the abdomen is filled up with CO2 gas, is applies a great amount of pressure upward to the diaphragm. If you were awake and had a regional block (epidural or spinal anesthesia), you would feel as if you were suffocating.
After surgery, you will be taken to the Recovery Room where you will stay for approximately one (1) to two (2) hours. After that time, you will be discharged home unless you had a major procedure. You will need to arrange a ride home, as you will be unable to drive for at least 24 hours.
AFTER THE SURGERY
The post-operative course following this procedure is variable, but in general you can expect to be fully recovered within 1 week. It may take longer if the procedure was complicated. You will need to restrain from vigorous physical activity for 24 hours following the procedure. In general, if you do something and it hurts, don’t do it. If you do something in it doesn’t hurt, feel free to continue what you are doing. Driving is permissible when you are completely mobile with only minimal pain.