Laparoscopy at Warwickshire Hospital

What is laparoscopy?

Sometimes called keyhole surgery, laparoscopy is a procedure that allows your doctor to inspect the organs in your abdomen and pelvis (uterus, tubes and ovaries) using a camera inserted through a small cut in the abdominal wall. A diagnostic laparoscopy will help to diagnose your problem, allowing your doctor to suggest management and treatments specific to you.

Laparoscopic surgery can be used to treat complications of conditions including:

• Crohn's disease 
• Colorectal cancer 
• Diverticulitis 
• Familial polyposis (a condition causing multiple colon polyps that puts you at higher risk of colorectal cancer )
• Bowel incontinence 
• Rectal prolapse (a protrusion of the rectum through the anus)
• Ulcerative colitis 
• Colon polyps that are too large to remove by colonoscopy 
• Chronic severe constipation that is not successfully treated with medication

What are the benefits of laparoscopy?

There are two types of laparoscopy, diagnostic and operative:

1. Diagnostic laparoscopy - this allows your doctor to assess your abdominal and pelvic organs to help to understand the cause of your symptoms and arrive at a diagnosis. The detailed assessment will allow your doctor to tailor treatment recommendations specific to your needs
2. Operative laparoscopy - this is a minimal access approach to surgery. This will allow your doctor to provide surgical treatment through very small cuts (incisions) in your abdominal wall (usually no more than 1cm). This means that you recover quicker and get back to normal far sooner than with “open” surgery, that occurs through larger incisions. Operations that can be done this way include Ovarian cystectomy (removal of ovarian cyst), Salpingo-oophorectomy (removal of fallopian tube and/or ovary) & Hysterectomy (removal of womb).

Is laparoscopy right for me?

Diagnostic laparoscopy is used to investigate many symptoms. It might be recommended if you experience:

• pelvic pain
• pain during your periods (dysmenorrhoea)
• pain during sexual intercourse (dyspareunia).

Common conditions diagnosed at a diagnostic laparoscopy would include, but are not limited to:

• endometriosis
• pelvic inflammatory disease
• adhesions (scar tissue)
• ovarian cysts
• fallopian tube abnormalities.

What happens during laparoscopy

Preparing for laparoscopy

Ensuring that you are in the best shape for surgery is important to aid your recovery. Actions such as stopping smoking and following a healthy, balanced diet will improve your recovery.

During surgery/treatment

During a laparoscopy, a small incision (0.5-1cm) is made near the belly button and a small tube is passed through the abdominal wall, which allows a laparoscope (camera) to inspect the abdominal cavity. Carbon dioxide gas is used to distend the abdominal cavity to create space to allow your doctor to see the abdominal structures more clearly. Extra incisions (cuts) may be made to allow the placement of other instruments to allow careful inspection of the abdominal cavity. For gynaecology cases, a uterine manipulator is used to allow the doctor to look in front of and behind the womb.

At the end of the procedure, the carbon dioxide gas is released and the incisions are closed by absorbable sutures (stitches).

A diagnostic laparoscopy usually takes no more than 30 minutes and is performed under general anaesthesia, but local anaesthetic is usually administered into the skin to reduce post-operative pain.

Recovery from laparoscopy

If you are having a diagnostic laparoscopy you should be able to go home on the same day (day case). The total recovery time is usually no more than 3-4 weeks before you are back to normal, and a full recovery has been made. It is a very safe procedure and complications are uncommon.

Short-term recovery

• Scars - you will have between one and four small scars on different parts of the abdomen.
• Dressings - The sutures (stitches) are absorbable and will be covered by dressings. The dressings would stay in place for 24 hours after your operation, after which they can be removed and you can wash or shower. After washing ensure your scars are gently dried, and pat with a clean towel or clean disposable tissues. Keeping scars clean and dry promotes healing.
• Vaginal bleeding -  for gynaecological cases you might get some vaginal bleeding or spotting for 1-2 days after the laparoscopy due to the use of the uterine manipulator.
• Pain -  You can expect to feel some pain in your abdomen and also your shoulder, but this is usually well controlled with painkillers.
• Blood clots - There is a small risk of developing blood clots in your legs (deep vein thrombosis) or lungs (pulmonary embolus) after an operation. This risk can be reduced by being mobile or doing leg exercises. Sometimes further measures to reduce the risk are used such as compression stockings or heparin injections (to thin the blood) if you are at particular risk of blood clots.
• Fatigue - You may feel tired as the body is using a lot of energy in the healing process, it is important for you to rest, especially in the first few post-operative days.

Tips for managing your recovery at home

• Exercise - you will be able to go for short walks from the day after a diagnostic laparoscopy, increasing your activity levels over the course of the first week. Most people will be back to their previous activity levels by two to three weeks following a diagnostic laparoscopy. Contact sports and power sports might need a few more weeks before pre-operative levels of activity are resumed
• Sexual activity - after a diagnostic laparoscopy it is safe to resume sexual activity when you feel ready
• Reaching/household chores - you can gradually begin to return to normal daily activities. You will be able to do increasingly more as days pass. If you feel pain use that as a guide to do a little less for a few more days and remember the importance of lifting correctly
• Dressing - you will be able to wear your normal clothes after a diagnostic laparoscopy, but many people prefer to have looser-fitting garments initially
• Stairs - there should not be any issue with stair climbing after a diagnostic laparoscopy
• Bathing - after 24 hours you can wash or shower. It is important to keep the scars clean and dry after bathing.

Driving after laparoscopy

You should not drive for 24 hours after a general anaesthetic and you should check with your driving insurance company for when you are insured to drive again.

Before you attempt to drive you should be free from the effects of any sedative painkillers, able to sit comfortably in the car and operate the controls, able to wear a seatbelt, able to make an emergency stop, and able to look over your shoulder comfortably.

Time off work following laparoscopy

Most will feel able to return to work within three weeks after a laparoscopy. After a diagnostic laparoscopy, you might feel ready to go back to work after one week. If you have had an operative laparoscopy, recovery is a little bit longer and you would expect to be able to return to work after three weeks, with the potential for light work after one week.

When you do return to work will depend on the type of work you do. If you do heavy manual work or work requiring you to be on your feet all day you may need longer to recover than someone who sits for work.

Follow up appointments

After your procedure, your doctor would usually see you in the outpatient clinic to discuss the findings and future management plans.