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Laparoscopy (Keyhole Surgery)

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Laparoscopy is a type of surgical procedure that allows a surgeon to access the inside of the abdomen (tummy) and pelvis without having to make large incisions in the skin.

 

This procedure is also known as keyhole surgery or minimally invasive surgery.

 

Large incisions can be avoided during laparoscopy because the surgeon uses an instrument called a laparoscope.  This is a small tube that has a light source and a camera, which relays images of the inside of the abdomen or pelvis to a television monitor.

 

The advantages of this technique over traditional open surgery include:

 

  • a shorter hospital stay and faster recovery time

  • less pain and bleeding after the operation

  • reduced scarring

 

When is a laparoscopy carried out?

 

Laparoscopy can be used to help diagnose and treat a wide range of conditions that develop inside the abdomen or pelvis. It can also be used to carry out surgical procedures, such as removing a damaged or diseased organ, or removing a tissue sample for further testing (biopsy). Example

 

  • pelvic inflammatory disease (PID) – a bacterial infection of the womb, fallopian tubes and ovaries

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  • endometriosis – where small pieces of the womb lining (the endometrium) are found outside the womb

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  • ectopic pregnancy – a pregnancy that develops outside the womb

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  • ovarian cysts – a fluid-filled sac that develops on a woman's ovary

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  • fibroids – non-cancerous tumours that grow in or around the womb 

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  • scar tissue (adhesions) - from previous surgery or infection

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  • female subfertility investigations

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  • appendicitis – a painful swelling of the appendix (a small pouch connected to the large intestine)

 

  • unexplained pelvic or abdominal pain​

 

Safety - Complications

 

Laparoscopy is a commonly performed procedure and serious complications are rare.

 

Minor complications are estimated to occur in 1 or 2 out of every 100 cases following laparoscopy. They include:

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  • infection of the bladder, wounds or chest

  • minor bleeding and bruising around the incision

  • feeling sick and vomiting

 

Serious complications after laparoscopy are estimated to occur in 1 out of every 1,000 cases. They include:

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  • damage to an organ, such as your bowel or bladder, which could result in the loss of organ function requiring return to theatre for further surgery

  • damage to a major blood vessel

  • conversion to an open procedure (a larger cut on the tummy)

  • complications arising from the use of carbon dioxide during the procedure, such as the gas bubbles entering your veins or arteries

  • a serious allergic reaction to the general anaesthetic

  • a blood clot developing in a vein, usually in one of the legs (deep vein thrombosis or DVT), which can break off and block the blood flow in one of the blood vessels in the lungs (pulmonary embolism)

 

How is a laparoscopy carried out

 

A laparoscopy is performed under general anaesthetic, so you will be unconscious during the procedure and have no memory of it. You can often go home on the same day.

 

Preparation

 

Depending on the type of laparoscopic procedure being performed, you'll usually be asked not to eat or drink anything for 6 to 8 hours beforehand.

 

If you're taking blood-thinning medication (anticoagulants), such as aspirin or warfarin, you may be asked to stop taking it a few days beforehand. This is to prevent excessive bleeding during the operation.

 

If you smoke, you may be advised to stop during the lead-up to the operation. This is because smoking can delay healing after surgery and increase the risk of complications such as infection.

 

Most people can leave hospital either on the day of the procedure or the following day. Before the procedure, you'll need to arrange for someone to drive you home and stay with you overnight because you'll be advised not to drive for at least 24 hours afterwards.

 

The procedure

 

During laparoscopy, the surgeon makes a small cut (incision) of around 0.5 to 1.5cm  in your belly button.

 

A tube is inserted through the incision, and carbon dioxide gas is pumped through the tube to inflate your tummy (abdomen). Inflating your abdomen allows the surgeon to see your organs more clearly and gives them more room to work. A laparoscope is then inserted through this tube. The laparoscope relays images to a television monitor in the operating theatre, giving the surgeon a clear view of the whole area. Depending on the what the laparoscopy is for, 1-3 further incisions will be made in your abdomen (usually 0.3-10mm). Small surgical instruments are inserted through these incisions to help inspect your internal organs and carry out the required treatment.

 

After the procedure, the carbon dioxide is let out of your abdomen, the incisions are closed using dissolvable stitches and a dressing is applied.

 

When a laparoscopy is used to diagnose a condition, the procedure usually takes about half an hour. It will take longer if the surgeon is treating a condition, depending on the type of surgery being carried out.

 

Recovery

 

After a laparoscopy, you may feel groggy and disorientated as you recover from the effects of the anaesthetic. Some people feel sick or vomit. These are common side effects of the anaesthetic and should pass quickly.

 

You'll be monitored by a nurse for a few hours until you're fully awake and able to eat, drink and pass urine. Before you leave the hospital, you'll be told how to keep your wounds clean and when to return for a follow-up appointment.

 

For a few days after the procedure, you're likely to feel some pain and discomfort where the incisions were made, and you may also have a sore throat if a breathing tube was used. You'll be given simple painkillers to help ease the pain.

 

Some of the gas used to inflate your abdomen can remain inside your abdomen after the procedure, which can cause bloating, cramps and shoulder pain (the gas can irritate your diaphragm (the muscle you use to breathe), which in turn can irritate nerve endings in your shoulder). These symptoms are nothing to worry about and should pass after a day or so, once your body has absorbed the remaining gas.

 

Recovery times

 

The time it takes to recover from a laparoscopy is different for everybody. It depends on factors such as the reason the procedure was carried out (whether it was used to diagnose or treat a condition), your general health and if any complications develop.

 

If you've had a laparoscopy to diagnose a condition (a diagnostic laparoscopy), you'll probably be able to resume your normal activities within 5 to 7 days.

 

An operative laparoscopy will have a longer recovery time - usually between 2 weeks for more minor surgery such as a sterilisation or removal of Fallopian tubes, to 6 weeks for a laparoscopic hysterectomy. You will be given personalised advice on your expected recovery time before you leave hospital. 

 

When to seek medical advice

 

It's usually recommended that someone stays with you for the first 24 hours after surgery. This is in case you experience any symptoms that suggest a problem, such as:

 

  • a high temperature of 38C or above

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  • chills

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  • severe or continuous vomiting

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  • increasing abdominal pain

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  • redness, pain, swelling, bleeding or discharge around your wounds

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  • abnormal vaginal discharge or vaginal bleeding

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  • pain and swelling in one of your legs

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  • a burning or stinging sensation when urinating

 

If you experience any of these symptoms during your recovery, you should seek medical advice from the team who carried out your operation, or out of hours,  NHS 111.

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