Pelvic laparoscopy

Alternative names
Celioscopy; Band-aid surgery; Pelviscopy

Definition
Pelvic laparoscopy is a surgical procedure that examines and treats pelvic organs through a small surgical viewing instrument (laparoscope) inserted into the abdomen at the navel.

Description

While the patient is deep asleep and pain-free under general anesthesia, a one-half-inch incision is made in the skin below the navel (umbilicus). Carbon dioxide is pumped into the abdomen to make the organs of the abdominal cavity more easily visible.

The laparoscope, an instrument similar to a small telescope on a flexible tube, is inserted so the area can be viewed. Other instruments may be inserted through other incisions in the lower abdomen to obtain tissue samples or perform additional procedures. After the laparoscopy, the carbon dioxide gas is released, and the incisions are stitched.

Indications

Pelvic laparoscopy is used both for diagnosis and for treatment and may be recommended for:

     
  • Pelvic pain due to:       o Uterine tissue found outside the uterus in the abdomen (endometriosis)       o Infections (pelvic inflammatory disease) not responsive to drug therapy       o Suspected twisting (torsion) of an ovary       o Ovarian cyst       o Scar tissue (adhesions) in pelvis  
  • Perforation (puncture) of the uterus following D and C or by an IUD  
  • Evaluation of infertility  
  • Sterilization (tubal ligation)  
  • Evaluation and removal of an abnormal pelvic mass that was confirmed by abdominal ultrasound  
  • Removal of uterine fibroids (myomectomy)  
  • Removal of uterus (hysterectomy)  
  • Surgical treatment of tubal pregnancy  
  • Evaluation of a woman who may have appendicitis or salpingitis

Pelvic laparoscopy is not recommended for patients with:

     
  • Severe obesity  
  • Existing severe pelvic adhesions from previous surgeries

Risks

General anesthesia poses the risk of reactions to medications, including breathing problems. Risks for any surgery include bleeding, infection, and damage to nearby organs and tissues.

Expectations after surgery

Laparoscopic procedures are growing more popular with physicians, especially with the advent of more high-tech laparoscopes.

Many of the procedures can be done on an outpatient basis, but an overnight stay may be necessary. Average time of surgery is about an hour, but this depends on the procedure performed.

Whether used as a diagnostic or as a therapeutic procedure, laparoscopy may eliminate the need for a large incision in the abdomen and a longer hospital stay. Laparoscopic surgery can be considered major surgery, depending on the procedure planned.

Unless major problems are uncovered during the procedure (such as severe bleeding, or an ectopic pregnancy), laparoscopy may be the only operation needed.

Convalescence

The gas pumped into the abdomen may cause abdominal discomfort for 1 or 2 days after the procedure.

Occasionally, neck and shoulder pain may be noted for several days after a laparoscopy as the carbon dioxide gas escapes through the skin. Normal activities may be resumed in less than 2 days.

Sexual activities may be resumed as soon as bleeding, if any, has stopped. Call your doctor if you have severe abdominal pain, persistent fever, or vaginal bleeding.

Johns Hopkins patient information

Last revised: December 2, 2012
by Arthur A. Poghosian, M.D.

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