Laparoscopy surgery
What is laparoscopic surgery?
Laparoscopy is looking inside the abdomen with a telescope. This procedure is used to make a diagnosis but also to carry out several surgical procedures and the common name used for this technique is laparoscopic or key-hole surgery. It is also known as minimal access surgery.
What are the common indications?
In gynecology, common indications for performing laparoscopic surgery are:
- Endometriosis(diagnosis and treatment)
- Ovarian cysts(cystectomy is often performed laparoscopically)
- Fibroids(myomectomy)
- Ectopic pregnancy (diagnosis and treatment)
- Hysterectomy (may be performed for heavy periods, fibroidsor endometrial cancer)
- Diagnosis and treatment of pelvic pain
How common is laparoscopic surgery?
Laparoscopic approach is now the default way of performing many standard operations including major procedures such as hysterectomy and myomectomy. Open surgery has now become relatively uncommon.
How is laparoscopic surgery performed?
Under general anesthesia, a small 5mm incision is made inside the umbilicus and a needle is inserted to inflate the abdominal cavity with gas. This is necessary to provide adequate space to perform the procedure safely. A telescope (long tube with camera at one end) is then inserted inside the abdomen. The image is displayed on a television screen and all surgery is carried out under direct vision. This can be recorded in the form of pictures and video.
Two or three further incisions are made (5-10 mm) to insert various instruments so that surgery can be carried out. This is often likened to painting a hallway through a letterbox! This is a complex skill acquired through many hours of practice and simulation training.
Common Complications:
-Pain, bleeding, fever due to infection, abscess, pulmonary embolism, complications due to anesthesia (sore throat, nausea and vomiting…), pelvic and abdominal wall adhesion, urination disorders, hospitalization, blood transfusion, reoperation, death
– Diminished ovarian reserve, early menopause, infertility, colostomy, fistula
– Damage to the pelvic organs including intestine, urinary system, fallopian tubes And ovaries
– Depending on the reason for the surgery it will be done; hysterectomy (remove the womb) and salpingectomy (remove the fallopian tubes), oophorectomy (remove the ovaries) and partial colectomy (remove the colon) or partial cystectomy (remove the bladder) at the doctor’s discretion
Necessary training for patients:
-Do not have intercourse till doctor’s permission
– Abstinence from costive and flatulent food
-Take clear liquids later the same day
-Walking
-Come to doctor to take bandages off
-Come to doctor with the pathology report
-In case of danger symptoms like; fever, pain, bleeding, infection, chest pain, dyspnea and every uncommon sign, see the doctor.
Hemovac Drain Care:
The hemovac drain removes fluid by creating suction in the tube. The circular device is squeezed flat. The device expands as it fills with fluid.
-Empty the drain when it is half full or every 4 to 8 hours: wash your hands with soap and water, remove the plug from the top of the drain, pour the fluid into a measuring cup, clean the plug with an alcohol swab or a cotton ball dipped in rubbing alcohol, squeeze the drain flat and put the plug back in. The drain should stay flat until it starts to fill with fluid again, make sure the tubing is not kinked or twisted. Refasten to your clothes below your surgery site so it does not pull at your skin, measure the amount of fluid you pour out. Write down how much fluid you empty from the drain and the date and time you collected it. Bring this record with you to your follow-up visits, flush the fluid down the toilet. Wash your hands. The amount of fluid that you drain should decrease each day. Ask your healthcare provider when and how your drain will be removed.