Laparoscopy is the inspection of the organs of the abdomen and pelvis using a specially designed telescope. A laparoscopy can be diagnostic or operative.

Diagnostic laparoscopy

This is usually performed to help diagnosis of certain complaints. The most common of these include pelvic pain, painful periods, painful sex, and infertility. During laparoscopy for infertility, dye is usually passed through the tubes from below to see if they are patent.

Operative laparoscopy

Many gynaecological operations can now be performed by laparoscopy. These types of operations are often called 'keyhole' operations. Examples of operations that can be performed laparoscopically included, hysterectomy, treatment to endometriosis, ovarian cyst treatment, sterilisation, colposuspension, myomectomy (removal of fibroids), and many more.

How the procedure is carried out

The tummy is filled with gas usually through the tummy button. A 5mm to 10mm scar is placed in the tummy button to achieve this. If an operative laparoscopy is being performed further small scars may be placed on either side of your tummy and in your bikini line.

Coming in, going home, and returning to work

Most diagnostic laparoscopies and some operative laparoscopies are done as day cases where a patient comes in and goes home on the same day. Women with other medical conditions or factors that may make the surgery more complicated may need to come into hospital for a night or two. Most women who have major operative laparoscopic procedures need to stay a night or two in hospital.

After a laparoscopy it is usual to have some pain in the tummy and around the shoulder tips. However, this should be treatable with pain relief. It should not limit a woman's ability to mobilise and be discharged. Vaginal bleeding is also quite common but should not be heavier than the worst day of a normal period and should not last more than about two weeks.

Following a diagnostic laparoscopy most women take a week off work. Following an operative laparoscopy, most women take two to three weeks off work depending on the complexity of the procedure and other coexisting medical conditions.

Complications

Most women have no complications. Things that can go wrong are listed below;

• Infection: Infection to the lung (from the anaesthesia), urine, and wound are quite common and may require antibiotics. Sometimes antibiotics are given during or after the operation to reduce this risk.
• Hernia: Any scar on the tummy may result in hernia. This is uncommon following laparoscopy and the rate is less than 1%.
• Death: Death from laparoscopy is uncommon and is usually related to when it is required for an emergency (such as ectopic pregnancy, or severe infection). The overall rate is 3 - 8 in 100,000 although this rate is considerably lower in an elective setting.
• Visceral damage: This is damage to the bowel, bladder, or ureter (tube connecting the kidney to the bladder). This is not always detected at the time of the operation and can result in a woman needing an open operation (laparotomy) or returning to theatre after the operation. Visceral damage is rare and occurs in less than 1% of cases.
• Open operation: Sometimes as a result of complications or because it is not possible to perform an operation through the laparoscope a woman requires an open operation (laparotomy). The risk of this varies with the type of operation ranging from under 1% for a diagnostic laparoscopy in a woman without any other medical or surgical problems to about 1 in 20 for some of the more major operative laparoscopic procedures.
• Return to theatre: Sometimes, a woman has to return to theatre as a result of complications. The risk of this is less than 1%.
• Haemorrhage: Haemorrhage and blood transfusion is a risk. This varies from less than 1% for a simple diagnostic laparoscopy to about 5% for the more complex myomectomies.
• Thrombo-embolic diseases: This group of diseases include a condition called deep vein thrombosis (DVT) where clots form in the legs and pulmonary embolus (PE) where a blood clot can go to the lung. Some women are more likely to get this than others. This can be one of the very rare causes of death when it occurs. The common name for this group of diseases is 'the economy class syndrome' as it has been reported in the press in women who travel on long haul flights. To reduce the risk, a number of measures are often performed such as compression boots in theatre, stocking, and heparin injections. However, the risk is very rare.
• Uterine perforation: This is where an instrument accidentally passes through the womb. It may rarely result in a woman needing an open operation or having to go back to theatre. However, this is rare. THere have also been rare case reports in the literature of women needing a hysterectomy but this is extremely rare and most gynaecologists have never witnessed this.
• No complications: Although it is important to inform a woman of potential complications, it is only informed consent if a woman is aware that most people have none. Recent guideline from the Royal College of Obstetricians and Gynecologist states that 998 of 1000 women have no serious complication.

Written by a private gynaecologist in London