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Laparoscopic tubal ligation

LMar 05 05

Alternative names
Exploratory laparoscopy - gynecologic; Gynecologic laparoscopy; Laparoscopic oophorectomy; Laparoscopic hysterectomy; Laparoscopic egg harvest

Definition

Gynecologic laparoscopy involves a group of minimally invasive surgical procedures on the female reproductive organs performed with the aid of a small camera.

How the test is performed

The first gynecologic procedures involving a laparoscope included exploratory laparoscopy to diagnose ovarian disease such as cysts, torsion, and cancer. Since then, more complex operations have developed, including laparoscopic removal of a tubal pregnancy, harvest of eggs for in vitro fertilization, and - more recently -laparoscopic removal of the uterus (hysterectomy) or the ovaries.

For complex laparoscopic operations, patients should consult with a primary health care provider to find a medical facility that specializes in the specific operation.

The procedure is usually done in the hospital, under general anesthesia. A catheter is inserted through the urethra into the bladder. An additional tube, called a nasogastric (NG) tube, may be passed through the nostril and into the stomach to remove intestinal contents. 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 tube called a trocar, which allows passage of a tiny video camera into the abdomen. Prior to insertion of the trocar, a needle is inserted into the incision and carbon dioxide gas is injected to elevate the abdominal wall, thereby creating a larger space to work in. This allows for easier viewing and manipulation of the organs.

The laparoscope is then inserted so that the organs of the pelvis and abdomen can be examined. Additional small incisions are made for instruments that allow the surgeon to move organs, cut tissue, suture, and staple structures as needed to safely and effectively perform the 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 drainage of accumulated fluid.

How to prepare for the test

Do Not eat or drink for 8 hours before the test.

You must sign a consent form before a gynecologic laparoscopic procedure.

Infants and children:
The preparation you can provide for this test depends on your child’s age, previous experiences, and level of trust. For general information regarding how you can prepare your child, see the following topics:

     
  • Infant test/procedure preparation (birth to 1 year)  
  • Toddler test/procedure preparation (1 to 3 years)  
  • Preschooler test/procedure preparation (3 to 6 years)  
  • Schoolage test/procedure preparation (6 to 12 years)  
  • Adolescent test/procedure preparation (12 to 18 years)

How the test will feel
If you are under general anesthesia, you will feel no pain during the procedure, although the incisions 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 anesthetic is given. Pain may occur at the incision site. Afterward, the incisions may throb for several hours and may be slightly painful. A pain reliever will be administered by your physician.

Additionally, you may experience shoulder pain for a few days, because the carbon dioxide gas used to inflate your abdomen can irritate your diaphragm, which shares some of the same nerves as the shoulder. You may also experience an increased urge to urinate, since the gas can put pressure on the bladder.

Depending on the procedure performed, your health care provider may advise you to avoid eating and drinking for a period of time after the procedure.

Why the test is performed
Gynecologic laparoscopy is performed for the same reasons as open surgery.

What abnormal results mean

Abnormal results are 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. This may require more involved surgery. Severe injury may result in infection or the need for blood transfusion.

Special considerations
The ability to perform laparoscopic surgery is limited by the presence of previous abdominal or pelvic surgery. Prior surgery may have led to scar formation, which prevents the safe passage of laparoscopic instuments into the abdomen, and may also prevent the abdominal wall from being effectively distended by the gas instillation.

Johns Hopkins patient information

Last revised: December 5, 2007
by David A. Scott, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.
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