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Gynaecological laparoscopy

Published by Bupa's health information team, September 2008.

This factsheet is for women who are planning to have a gynaecological laparoscopy, or who would like information about it.

Gynaecological laparoscopy is a keyhole procedure that allows a doctor to examine the fallopian tubes, ovaries and womb.

Your care will be adapted to meet your individual needs and may differ from what's described here. So it's important that you follow your doctor's advice.

About gynaecological laparoscopy
What are the alternatives?
Preparing for your procedure
About the procedure
What to expect afterwards
Recovering from a gynaecological laparoscopy
What are the risks?
Further information
Questions and answers
Related topics
Sources

About gynaecological laparoscopy

Gynaecological laparoscopy is used to look inside your pelvic area and examine your fallopian tubes, ovaries and womb. The procedure involves passing a medical telescope with an attached camera (a laparoscope) into your abdomen (tummy) through a small cut. Your doctor will examine your organs by looking at pictures sent to a monitor.

Gynaecological laparoscopy can be either diagnostic (used to diagnose a condition) or operative (used to treat a condition).

Gynaecological laparoscopy is commonly used to:

diagnose and treat endometriosis (when the lining of the womb grows outside the womb)
diagnose and treat pelvic inflammatory disease (inflammation of the ovaries, womb or fallopian tubes)
remove scar tissue
treat an ectopic pregnancy (when the fertilised egg implants outside the womb)
perform female sterilisation (permanent birth control)
monitor the effects of fertility medicines on the ovaries
remove an ovarian cyst or take a biopsy
remove the womb (hysterectomy) or ovaries
remove lymph nodes for cancer care
perform incontinence and prolapse surgery

What are the alternatives?

Depending on your symptoms and circumstances, alternative options may include:

imaging techniques - ultrasound, CT or MRI scans can help diagnose or monitor some health conditions
open surgery - this involves making a single large cut on your abdomen

Your doctor will explain your options to you.

Preparing for your procedure

Your doctor will explain how to prepare for your procedure. For example if you smoke you will be asked to stop, as smoking increases your risk of getting a chest infection or wound infection and slows your recovery.

Diagnostic gynaecological laparoscopy is done as a day case under general anaesthesia. This means you will be asleep during the procedure. Operative laparoscopy, for example a hysterectomy, usually involves an overnight stay and is also done under general anaesthesia.

You will be asked to follow fasting instructions. Typically you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

At the hospital your nurse may do some tests such as checking your heart rate and blood pressure, and testing your urine.

Your doctor will visit you to discuss the procedure and ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.

About the procedure

The procedure can last from 15 minutes upwards, depending on what type of examination or treatment you need.

Your doctor will make a cut in your belly button. A plastic tube is inserted and gas is introduced into the abdomen. This expands your abdomen and allows your doctor to see inside with the laparoscope. An alternative method for introducing gas is using a hollow needle.

If you need any treatment or surgery, your doctor will make additional small cuts in the lower part of your abdomen to allow access for surgical instruments. Your doctor may inject a coloured dye through your cervix into your womb and your fallopian tubes to help show that there is no blockage in your tubes.

Once the examination is complete, the instruments are carefully taken out and the gas is allowed to escape through the laparoscope. Your doctor will close the cuts with stitches.

Your doctor may insert a catheter to drain urine from your bladder into a bag.

Illustration showing a gynaecological laparoscopy
A gynaecological laparoscopy

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed.

You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Your nurse will give you some advice about caring for your wounds, hygiene and bathing before you go home. You may be given a date for a follow-up appointment.

Dissolvable stitches will disappear on their own in seven to ten days. Your doctor may suggest a visit to your practice nurse to have the wounds checked and the sutures removed at five to seven days.

Recovering from a gynaecological laparoscopy

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice.

General anaesthesia can temporarily affect your coordination and reasoning skills, so you shouldn't drink alcohol, operate machinery or sign legal documents for 48 hours afterwards.

You shouldn't drive until you feel you could do an emergency stop without discomfort. If you're in any doubt about driving, please contact your motor insurer so that you're aware of their recommendations, and always follow your doctor's advice.

You will need to take it easy for a day or two, or longer if you have a hysterectomy. You may be able to return to work within a couple of days, but this depends on the exact type of examination and treatment you have. It can take several weeks to make a complete recovery.

Follow your doctor's advice about resuming sexual activity and contraception.

Most women experience no problems after having a gynaecological laparoscopy. However, if you develop any of the following symptoms, contact your doctor:

prolonged heavy bleeding
unpleasant vaginal discharge
severe pain or pain that lasts for more than 48 hours
high temperature
wound redness or pain

What are the risks?

Gynaecological laparoscopy is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted, but mostly temporary effects of a successful treatment, for example feeling sick as a result of the general anaesthetic.

You may have some vaginal bleeding after the procedure. If a dye was used, you may have a dark vaginal discharge for a day or two.

You're likely to feel some pain in the abdomen as well as in the tips of your shoulders caused by the gas used to inflate your abdomen. This usually clears within 48 hours.

You may have some abdominal bruising. This usually settles without treatment.

Complications

This is when problems occur during or after the procedure. Most women aren't affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Other complications specific to gynaecological laparoscopy are listed here.

Very rarely during the procedure, other tissues in your abdomen (such as the bowel, bladder or major blood vessels) may be accidentally damaged. In extremely rare cases, these complications can be fatal.
Very rarely during the procedure, your womb may be damaged or perforated. This can lead to bleeding and infection, and may require further surgery or, in extremely rare cases, the womb is removed.
There's a chance your doctor may need to convert your keyhole procedure to open surgery. This means making a bigger cut on your abdomen. This is only done if it's impossible to complete the procedure safely using the laparoscope.

The exact risks are specific to you and will differ for every person, so we haven't included statistics here. Ask your doctor to explain how these risks apply to you.

Further information

Royal College of Obstetricians and Gynaecologists
www.rcog.org.uk
Women's Health Concern
0845 123 2319
www.womens-health-concern.org