|
2) Laparoscopy
Introduction
Nowadays, it is possible to look inside
the abdomen and even perform surgery inside the human body without
making a large cut or incision on the abdomen. With technological
advancement and innovation, many of our traditional surgeries can be
safely performed under this “minimally invasive” technique. Under
the field of gynaecology, the 2 main types of surgery are:
Laparoscopy and Hysteroscopy.
Laparoscopy
Laparoscopy is a procedure to look
inside of the abdomen and pelvis using a laparoscope. This helps to
see the ovaries, outside of the tubes and uterus and other organs
inside the abdomen. The laparoscope is a special telescope to which
a light source and camera is attached. It is about as thick as a pen
and about 12 cm long. Laparoscopy is commonly used to :
-
find the cause of symptoms such as
abdominal pain, pelvic pain
-
as part of investigation of
infertility.
In addition to simply looking inside, a
doctor can use fine instruments to perform surgery inside the
abdomen. This laparoscopic surgery is also called 'key-hole surgery'
or 'minimal invasive surgery' and maybe used to treat cysts,
endometriosis, fibroids, perform hysterectomy and even pelvic floor
reconstruction.
In general, compared to traditional
surgery, with laparoscopic surgery there is usually :
Hysteroscopy
This involves putting in a telescope to
see the inside of the womb.
Prior to Surgery
You will require to fast for at least 6
hours before the surgery. You will be given instructions regarding
the time from when you should begin fasting and when to come in to
the hospital.
Bowel Preparation
Your surgeon will instruct you regarding
the bowel preparation if required. This will entail drinking a
purgative the evening before surgery and taking light (eg soup) diet
the night before surgery. Usually this will lead to you having
diarrhea. While unpleasant, this procedure minimizes the risk of
surgical complications from bowel injury during your surgery.
In the Operating Theatre
The nurse anesthetist or
anesthesiologist will place four adhesive tabs on your chest to
monitor your heart rate.
An intravenous drip will be set to help
give you the required medication and fluids during surgery. The
anesthetist will then give you a mask to breathe into and will
administer some medication that will make you go off to sleep.
The surgeons will make a small about
1-1.5 cm cut inside your navel and through this, the laparoscope
will be introduced. Carbon dioxide gas (CO2) will be put into the
abdomen through a special instrument inserted into the navel. This
gas helps to distend the abdomen, making it easier for the surgeon
to see the internal organs during laparoscopy. The gas will be
removed at the end of the procedure.
Two or three small ½ cm cuts will be
made on the lower abdomen to put in the other instruments to be able
to perform the surgery. At the end of the surgery, these will be
repaired using dissolvable material.
After Surgery
After surgery, you will wake up in the
Recovery Room. You will be transferred to the ward from the Recovery
Room about one hour after surgery.
You will be having an intravenous drip
running after the operation till you are able to tolerate feeds.
Injectable medication will be given for pain or nausea. You can tell
your nurse if you are uncomfortable and need more pain relief.
You may experience a sore throat. This
is caused by irritation from a tube placed through your throat into
the windpipe (trachea) during anesthesia. It usually lasts for just
a few days and can sometimes be helped by throat lozenges.
You may have a tube draining urine after
the operation and your surgeon will decide when it is to be removed.
If there is no tube draining urine, you can ask for a bedpan to
empty your bladder. Your surgeon will decide when you will be
allowed to go back home. This maybe 4 - 6 hours after surgery at the
earliest.
Gas Pains
You may have some pain in your shoulder
tip. This is caused by the gas which had been pumped inside
irritating the diaphragm which has the same nerve supply as the
shoulder tip. This pain passes off in a couple of days.
Recovery after a laparoscopic procedure
is very rapid. There is no need for bed rest and most patients are
able to resume full activities within a few days to a week after
laparoscopy.
Possible complications of Laparoscopy
:
There may be some minor bleeding or
bruising around the skin incisions.
Post operative infections or allergic
reactions to medications used may occur as well. Occasionally
retention of urine, or clot formation in the legs may occur.
Possible serious complications which
may occur include the following :
-
Accidental damage to structures
inside the abdomen such as the intestines, urinary bladder,
ureters (tubes that bring urine from the kidneys to the urinary
bladder), uterus (womb) or certain blood vessels. This is rare
and happens in about 3 - 4 per 1000 procedures but if it occurs,
a cut on the abdomen may be needed to correct the damage.
-
Excessive bleeding and the formation
of hematomas (blood collections) of the abdominal wall near the
incisions. This may occasionally require blood transfusion
-
As with any operation, there is a
small risk of complications of anaesthesia. Certain conditions
like previous abdominal surgery, presence of adhesions, severe
endometriosis, pelvic infections, obesity, or excessive thinness
may increase the risk of these complications. If complications
occur, the hospital stay will be prolonged.
The risk of death during laparoscopy is
very rare - about 3 - 8 per 100,000 and is less than the risk of
death during pregnancy.
|
