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What is laparoscopy in gynecology?
Laparoscopy in gynecology (gynecological laparoscopy) is a less invasive alternative to open surgery. The procedure involves using a laparoscope (a long, thin tube with a light connected to a camera) to look inside the pelvic area to diagnose gynecological disorders or to perform surgery to treat gynecological conditions. A small incision is made over the abdomen through which the laparoscope is inserted. Two to three other small incisions may be made to insert specialized surgical instruments. Open surgery is more invasive and usually requires a large incision. Healing is also generally faster with laparoscopic procedures.
Why is laparoscopy in gynecology done?
Laparoscopy in gynecology may be performed for diagnosis, treatment or both.
Indications for diagnostic laparoscopy include
Gynecological conditions that may be diagnosed by performing a laparoscopy include
- Ovarian tumors or cysts
- Uterine fibroids
- Ectopic pregnancy (pregnancy occurring outside the uterus)
- Pelvic adhesions
- Pelvic abscess
- Cause of infertility
- Pelvic inflammatory disease
- Cancer of the reproductive organs
Laparoscopy may be used in the treatment of the following gynecological conditions
- Removal of the uterus (hysterectomy)
- Removal of tumors from the ovary or uterus
- Endometriosis (presence of endometrial tissue, the tissue that lines the inside of the uterus, at sites outside the uterus)
- Removal of adhesions and scar tissue
- Tubal sterilization (permanent sterilization)
- Surgery to treat prolapsed uterus (when the internal supports of the uterus become weak making it descend towards or outside the vagina)
How is laparoscopy in gynecology performed?
During the procedure
Laparoscopy is usually performed under general anesthesia. Hence, there is no pain during surgery. This means you will be unconscious for the procedure. A needle is inserted into the abdomen to fill the abdomen with carbon dioxide gas. The gas widens the abdominal cavity by allowing a clearer view of the organs, keeps the abdominal wall away from the organs and reduces the risk of injury to the abdominal organs. The surgeon makes a small incision below the umbilicus (belly button) through which the laparoscope is inserted. The camera attached to the laparoscope transmits the video to a screen giving a clear and magnified view of the pelvic structures. The video can also be recorded for future reference. If the procedure is being performed only to make a diagnosis, only one incision is required to insert the laparoscope. If a surgical procedure is to be performed, additional small incisions would be required through which the surgical instruments would be inserted. Once the procedure is over, the incisions are sutured (stitched) and dressed.
After the procedure
After the procedure, the patient would have to stay in the hospital until the anesthesia wears off, but the patient needs to have someone drive them home. Patients are usually discharged on the same day or 24 to 48 hours after the procedure, depending on what was done. Patients can resume their daily activities in 1 to 2 days but are advised to avoid straining, heavy lifting, sports, exercise and other specific activities until the surgeon allows it. Recovery time depends on the procedure performed. It varies from a few days to a few weeks. Patients may experience pain, swelling and bruising, which usually resolves in a few days. Painkillers and antibiotics are usually prescribed. Recovery following laparoscopic procedures is faster than recovery after open surgery.
What are the complications of laparoscopy in gynecology?
Serious complications of laparoscopic procedures are rare. Some possible complications include
- Pelvic pain
- Hematoma (blood clots)
- Blood clots within the blood vessels, especially in the deep veins of the legs (deep vein thrombosis or DVT)
- Difficulty urinating
- Improper wound healing
- Scarring and adhesions
- Damage to the surrounding structures like the bowel, bladder, muscles, nerves, major blood vessels and other tissues
- Reaction to anesthesia
The risk of complications increases in the following cases
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