Laparoscopy

Laparoscopy is a surgical procedure used to examine the abdominal and pelvic cavities. During the procedure, the doctor uses an endoscope, a thin tube equipped with a camera lens and light. An endoscope used only in the abdominal area is called a laparoscope. Sometimes, a laparoscope is used with other types of instruments for surgical repair or to provide other types of treatment.


Indications
Laproscopy is used to diagnose and treat gynecologic and gastrointestinal problems. It may be recommended to:
identify possible causes of infertility or chronic pelvic pain
treat scar tissue
remove cysts, tumors or foreign bodies (such as a lost intrauterine device, or IUD, that perforated through the uterus)
remove the appendix, gallbladder or spleen
repair a hernia
perform tubal sterilization or assist with a vaginal hysterectomy (surgical removal of the uterus)
Laparoscopy may also be used to detect and treat various conditions, including:

ectopic pregnancy (a pregnancy in which the fertilized egg implants itself outside the uterus)
cysts (fluid-filled growths)
fibroids (benign tumors of connective and muscular tissue, usually found in the uterus)
adhesions or scar tissue
pelvic masses or tumors
endometriosis (a condition in which the tissue that lines the uterus grows outside the uterus)
infections (such as pelvic inflammatory disease)

Patient preparation
You won't be allowed to eat or drink after midnight the night before surgery. Depending on the circumstances -- including your medical history and the surgical protocol at the medical facility you have chosen -- you may need blood work, a urinalysis, a chest X-ray and an electrocardiogram (a recording of the electrical activity of the heart) before your surgery.
A laparoscopy is typically an outpatient procedure, so arrange for someone to drive you home after surgery. You may also want someone to help you at home for a day or two.


Procedure
Laparoscopy is usually done by a gynecologist or general surgeon. The procedure is typically done under general anesthesia, which induces unconsciousness temporarily. You'll lie slightly tilted, with your feet higher than your head. This allows your abdominal organs to fall toward your chest, making it easier for the doctor to examine your lower pelvic organs. A gas (such as carbon dioxide) will be pumped into your abdomen through a small needle to separate the organs and tissues from one another and help the doctor see the area better.
Next, the laparoscope is inserted through a small incision near your navel (belly button). If necessary, special instruments can be passed through the laparoscope or through additional small incisions lower in the abdomen. After the procedure, the gas is allowed to escape and the incisions are closed with a few stitches. The stitches may be covered with a small adhesive bandage.

Keep in mind that there may be a variation in the procedure due to your medical history and the extent of the surgical procedure. Discuss these issues with your doctor before surgery.


Postprocedure care
You'll rest at the medical facility for a few hours after surgery. If there are no complications, you'll probably be sent home the same day. Your doctor may suggest taking mild pain relievers for a day or two. You may need to limit your activities and avoid carbonated beverages for the next few days. Also, wait to have sex until your doctor says it's OK. While you're recovering, call your doctor if:
You notice signs of infection (an increase in swelling, redness, unusual drainage or fever).
You have more cramping or bleeding than you anticipated or were told to expect.
You feel dizzy or faint.
You have chest pain or difficulty breathing.
Your pain gets worse.
Your abdomen becomes more distended (stretched out or inflated) with time, instead of less distended.

Benefits
Here are a few benefits of laparoscopy, as compared to conventional surgery:
smaller abdominal incisions
shorter hospital stays (if hospitalization is necessary at all)
quick recovery time
early return to normal activity
less postoperative pain

Risks
The risks of laparoscopy are infrequent but can include:
injuring an organ (such as the bladder or bowel)
infection
bleeding
perforation of one of the major arteries or veins in the abdomen
shoulder or chest pain after surgery due to unabsorbed or unreleased gas
for a small percentage of patients, the need to convert to a traditional open abdominal surgery
There are also risks associated with general anesthesia. Discuss your concerns with your doctor or anesthesiologist before the procedure.


Considerations
Discuss potential outcomes with your doctor before surgery. Success rates may vary based on your condition, the exact procedure and the doctor's skill. The procedure is technically demanding, so make sure your doctor has developed expertise through experience as well as specialized training. If yout and treat certain conditions, such as ovarian tumors, appendicitis (inflammation of the appendix) and cholecystitis (inflammation of the gallbladder). Current studies show little increased risk of fetal complications when laparoscopy is done during the first trimester, but the use of laparoscopy during pregnancy is still somewhat controversial. Again, it, the chance of having one or more medical conditions increases. The possibility of needing a laparoscopy and the risk of developing complications depends on your health status. Discuss any concerns with your doctor.