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Pelvic laparoscopy
Pelvic laparoscopy

Gynecologic laparoscopy
Definition:
Gynecologic laparoscopy is the term given to a group of minimally invasive operations involving the female reproductive organs; these operations are performed with the aid of a camera. The initial procedures included exploratory laparoscopy to diagnose ovarian pathology such as cysts, torsion, and cancer. Subsequently, more complex operations have developed, including laparoscopic removal of a tubal pregnancy, harvest of eggs for in vitro fertilization, and more recently, the laparoscopic removal of the uterus and/or ovaries.

For complex laparoscopic operations, patients should consult with their primary health care provider to find a center of excellence in the specific operation.
Alternative Names:
Exploratory laparoscopy - gynecologic; Laparoscopic tubal ligation; Laparoscopic oophorectomy; Laparoscopic hysterectomy; Laparoscopic egg harvest
How the test is performed:

The procedure is usually done in the hospital, under general anesthesia, and after informed consent has been obtained. A catheter (a small flexible tube) is inserted through the urethra into the bladder. An additional tube may be passed through the nostril and into the stomach to remove intestinal contents (N-G tube). The skin of the abdomen is cleansed, and sterile drapes are applied.

A small incision is made above or below the navel to allow the insertion of a trocar (essentially a tube extending from inside the abdomen to the outside), which allows passage of a video camera. Prior to insertion of the trocar, a needle is inserted into the incision and carbon dioxide gas is injected to elevate the abdominal wall, and thereby create a larger space to work in. This allows for easier viewing and manipulation of the organs.

After an adequate amount of gas is instilled, the laparoscope is inserted, and the organs of the pelvis and abdomen are examined. Additional small incisions are made for instruments that allow the surgeon to move the abdominal organs, cut tissue, suture, and staple structures to safely and effectively perform the necessary procedure.

Following the examination, the laparoscope is then removed, the incisions are closed with sutures, and bandages are applied. Depending upon the operation performed, a drain may be left through one of the incisions to allow for removal of accumulated fluid.
How to prepare for the test:
You cannot have any food or fluid for 8 hours before the test. You must sign a consent form.

Infants and children:
The physical and psychological preparation you can provide for this or any test or procedure depends on your child's age, interests, previous experiences, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child's age:



How the test will feel:
Under general anesthesia, no pain will be felt during the procedure, however the incisions site may throb and be slightly painful afterward. A pain reliever may be given by your physician.

With local anesthesia, you may feel a prick and a burning sensation when the local anesthetic is given. Pain may occur at the incision site. Afterward, the incisions may throb for several hours and be slightly painful. A pain reliever will be administered by your physician.

Additionally, you may experience shoulder pain for a few days, since the gas can irritate the diaphragm, which shares some of the same nerves as the shoulder. Finally, you may experience an increased urge to urinate, since the gas can put pressure on the bladder.

Additionally, the specific procedure performed may preclude the ability to drink liquids or eat solid foods, until it is considered safe to do so, by your health care provider.
Why the test is performed:
The indications for operation are the same as the indications for an open procedure.
What abnormal results mean:
  • Specific to the operation performed.
What the risks are:
There is a risk of puncturing an organ, which could cause leakage of intestinal contents, or bleeding into the abdominal cavity. These complications often result in the conversion of laparoscopy to laparotomy. Severe injury may result in infection and/or a requirement for blood transfusion.
Special considerations:
The ability to perform laparoscopic surgery is limited by the presence of previous abdominal or pelvic surgery. Often prior surgery induces scar formation, which prevents the safe passage of the trocars into the abdomen, and may prevent the abdominal wall from being effectively distended by the gas instillation.
Review Date: 6/7/2001
Reviewed By: Allan S. Stewart, M.D., Department of Surgery, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

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