Pelvic Laparoscopy

Laparoscopy is minimally invasive, advanced keyhole surgery, which is used to diagnose pelvic conditions, take biopsy samples, and treat common reproductive problems. This involves making small incisions instead of the larger one needed for open surgery. A laparoscope is a thin, pliable surgical telescope with a camera on the end of it. It is used to diagnose and treat conditions including pelvic inflammatory disease, endometriosis, ectopic pregnancy, ovarian cysts, appendicitis, and infertility. It can also be used to perform sterilization in females.

Pelvic laparoscopy is a type of surgery that allows the doctor to see and treat organs and tissues inside the pelvis with a laparoscope. In pelvic laparoscopy, surgical tools are threaded through the smaller incisions and around tissues instead of cutting through them. This generally results in quicker recovery and less pain than open surgery.

Conditions: A pelvic laparoscopy is a major surgical procedure that may be recommended to treat a variety of diseases and conditions of the pelvic organs. These include the bladder, rectum, prostate, and female reproductive organs. For some of these conditions, hysterectomy or pelvic laparoscopy may only be considered if other treatment options that involve less risk of complications have been ineffective. Additionally, some conditions may require more invasive surgery.

Appendicitis: An inflammation and possibly infection of the appendix.
Cancer of the rectum, bladder or a woman’s reproductive organs or a man’s prostate gland.
Unexplained chronic pelvic or lower abdominal pain does not improve with other treatments.
Ectopic pregnancy: A pregnancy that grows in the fallopian tube instead of in the uterus.
Endometriosis: An abnormal growth of uterine tissue outside the uterus. Laparoscopy is the most common procedure used to diagnose and remove mild to moderate endometriosis. If endometriosis or scar tissue needs to be removed, your surgeon will use one of various techniques, including cutting and removing tissue (excision) or destroying it with a laser beam or electric current (electrocautery). Laparoscopy is used to examine the pelvic organs and to remove implants and scar tissue in the case of severe endometriosis, endometriosis pain that has continued or returned after hormone therapy, severe endometriosis pain or an endometriosis cyst on an ovary (endometrioma).
Fecal or urinary incontinence: Pelvic laparoscopy is used to identify the underlying cause and treat several types of urinary incontinence as well as fecal incontinence.
Infertility: Pelvic laparoscopy may be used to diagnose and treat the underlying cause of infertility. If infertility is the primary concern,the doctor will probably use laparoscopy to look for and remove signs of endometriosis. Removing mild endometriosis may not improve fertility, but surgery will improve your chances of pregnancy in case of moderate to severe endometriosis. In some severe cases, a fertility specialist will recommend skipping surgical removal and using in vitro fertilization.
Ovarian cysts: Cysts that grow on the ovaries.
Ovary torsion: A twisted position of the ovary that cuts off circulation to the ovary.
Pelvic inflammatory disease or tubo-ovarian abscess: An infection of a woman’s reproductive organs, often due to a sexually transmitted diseases.
Rectal or vaginal prolapsed: Dropping of the rectum or vagina out of it normal position.
Tissue biopsy: For removing samples of tissues to be examined for disease or cancer.
Uterine fibroids: Benign tumors of the uterus.

Procedure:

Generally patients are advised not to eat or drink six to 12 hours before the operation, to stop smoking, and to avoid blood-thinning medications in the week prior to the operation. This helps prevent excess blood loss.

A small incision is made above or below the navel area and a needle is inserted into the abdomen. Through this incision carbon dioxide gas is pumped into the area to enlarge and separate the organs to have a better view of the area. A second incision is made and the laparoscope is inserted. Laparoscope has a camera on the end with optic lighting, which transmits close-up images of the pelvic area on to a television monitor. If keyhole surgery is being performed additional incisions are made and small instruments attached to the laparoscope to perform the surgery. A biopsy or small sample of tissue is sometimes taken using the laparoscope to enable doctors to determine what the problem is. This can be useful if a patient has unexplained pelvic pain. With gynaecological operations, coloured dye is sometimes used to identify blocked areas in the womb and cervix so that surgeons can pinpoint where to treat. A catheter is also used to drain urine so that bladder emptying does not interfere with the progress of the operation. Once the procedure is finished the carbon dioxide gas is drained and the area stitched and dressed.

Recovery: It is minimally invasive using small cuts, dissolvable stitches and leaves neat scars and is done in outpatient clinic. The recovery time is shorter than with traditional surgery. The patient may have some anesthesia effects and have a slightly tender abdomen and shoulder tip. Pain relief will be issued for this. Mild bloating and bruising around the area of surgery will disappear after a few days. It is sensible to avoid driving or operating machinery for one to two days after the operation.

Complications: Pelvic infection, uncontrolled bleeding that result in the need for a larger abdominal incision (laparotomy) to stop the bleeding, scar tissue formation after surgery, damage to the bowel, bladder, or ureters. Blood clots in the leg or pelvic veins, which could travel to the lungs and, rarely, be fatal. This eventually leads to breathing problems, damage to nearby organs and tissues, heart problems or infection. Certain women are at an increased risk of complications in case of any surgical procedures. Women who are overweight, smoke, or have cardiovascular or pulmonary diseases are more prone to pelvic laparoscopy complications. It is, therefore, best that they discuss their surgical risks with their surgeon.

Advantages: The major advantage is that most of these procedures can be done on an outpatient basis, but one may have to stay at the clinic overnight. The time taken for a pelvic laparoscopy could be anything from 20 minutes to two hours depending on the amount of work required. Laparoscopy prevents the need for larger surgical cuts as compared to conventional surgery and the resultant pelvic laparoscopy scars are minimal. Costs also vary depending on whether it is a simple diagnostic test or used for treating any condition.