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Pelvic laparoscopy

Definition

Pelvic laparoscopy is a surgical procedure that examines and treats pelvic organs through a small surgical viewing instrument (laparoscope) inserted into the abdomen at the navel.

Alternative Names

Celioscopy; Band-aid surgery; Pelviscopy; Gynecologic laparoscopy; Exploratory laparoscopy - gynecologic

Description

While you are deep asleep and pain-free under general anesthesia, the doctor makes a half-inch surgical cut in the skin below the belly button. Carbon dioxide gas is pumped into the abdomen to help the doctor see the organs more easily.

The laparoscope, an instrument that looks like a small telescope with a light and a video camera, is inserted so the doctor can view the area.

Other instruments may be inserted through other small cuts in the lower abdomen. While watching a video monitor, the doctor is able to:

• Get tissue samples (biopsy)
• Look around and diagnose the cause of any symptoms
• Remove scar tissue or other abnormal tissue, such as from endometriosis
• Repair or remove part or all of the ovaries or tubes
• Repair or remove parts of the uterus
• Do other surgical procedures (such as appendectomy, removing lymph nodes)

After the laparoscopy, the carbon dioxide gas is released, and the surgeon closes the cuts with stitches.

The average time of surgery depends on the procedure performed.

Why the Procedure Is Performed

Laparoscopy may prevent the need for a large surgical cut in the abdomen and a longer hospital stay. There is less blood loss with laparoscopic surgery and less pain in the first several weeks after surgery.

Pelvic laparoscopy is used both for diagnosis and treatment. It may be recommended for:

• An abnormal pelvic mass or ovarian cyst found on pelvic ultrasound
• Cancer (ovarian, endometrial, or cervical) in order to:
  • Look for spread of the cancer and perform a biopsy (called staging)
  • Remove lymph nodes or pelvic organs
• Chronic (long-term) pelvic pain, if no other cause has been found
• Evaluating and treating infertility
• Removing the uterus (hysterectomy)
• Removing uterine fibroids (myomectomy)
• Sterilization (tubal ligation)
• Sudden, severe pelvic pain (may be caused by twisting of an ovary, appendicitis, perforation of the uterus, or salpingitis)
• Surgically treating a tubal pregnancy
• Uterine tissue found outside the uterus in the abdomen (endometriosis)

Risks

General anesthesia poses the risk of reactions to medications, including breathing problems. Risks for any pelvic surgery include:

• Bleeding
• Blood clots in the leg or pelvic veins, which could travel to the lungs and, rarely, be fatal
• Breathing problems
• Damage to nearby organs and tissues
• Heart problems
• Infection

Before the Procedure

Always tell your doctor or nurse:

• If you are or could be pregnant
• What drugs you are taking, even drugs, herbs, or supplements you bought without a prescription

You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.

On the day of your surgery:

• You will usually be asked not to drink or eat anything after midnight the night before your surgery, or 8 hours before your surgery.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital or clinic.

Arrange for a ride home after surgery.

After the Procedure

You will spend some time in a recovery area as you wake up from the anesthesia.

Often, you will be able to go home the same day as the procedure. Sometimes, you may need to stay overnight.

Outlook (Prognosis)

The gas pumped into the abdomen may cause abdominal discomfort for 1 - 2 days after the procedure. Some people feel neck and shoulder pain for several days after a laparoscopy as the carbon dioxide gas irritates the diaphragm, a pain which is felt in the shoulder. As the gas is absorbed this pain will go away. Lying down can help decrease the pain.

Your doctor will give you a prescription for pain medicine or tell you what over-the-counter pain medicines you can take.

You may resume your normal activities in fewer than 2 days. Depending on what procedure is done, you can usually begin sexual activities again as soon as the bleeding (if there is any) has stopped. Ask your doctor what is recommended for the procedure you are having. Do not lift anything over 10 pounds for 3 weeks after surgery to decrease your risk of getting a hernia in your incisions.

Call your doctor if you have:

• Bleeding from the vagina
• Fever that doesn't go away
• Nausea and vomiting
• Severe abdominal pain

References

Katz VL. Diagnostic procedures, imaging, endometrial sampling, endoscopy: Indications and contraindications. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby; 2007: chap 11.

DeSimone CP, Ueland FR. Gynecologic laparoscopy. Surg Clin North Am. 2008;88:319-341.