Laparoscopic Surgery

At University Women's HealthCare, we perform a wide range of minimally invasive, advanced laparoscopic procedures on an outpatient basis. Because total and supracervical hysterectomies are performed laparoscopically, patients are usually able to go home the same day or the following day. Other advanced laparoscopic surgeries we perform include laparoscopic myomectomy (removal of fibroids), laparoscopic treatment of endometriosis and pelvic pain, pelvic floor reconstruction, and treatment for urinary incontinence.

Conditions suited for laparoscopic surgery include:

• Hysterectomy (total laparoscopic and supracervical
  hysterectomy)
• Diagnostic laparoscopy
• Tubal occlusion (sterilization)
• Ovarian cysts
• Tubal cysts
• Endometriosis
• Fibroids
• Pelvic pain
• Adhesions
• Infertility evaluation and tubal surgery
• Ectopic pregnancy
• Bladder suspension surgery for urinary incontinence
• Pelvic floor repair
• Reanastomosis of tubes following a sterilization procedure

What are contraindications to laparoscopic surgery?

• Systemic health problems, especially cardio-pulmonary problems, that may be aggravated by general anesthesia maybe a contraindication to laparoscopy. An anesthesia consult is recommended if there is any uncertainty about the woman’s surgical status.
• A history of multiple abdominal surgeries that may limit the surgeon’s ability to gain access to the pelvis at surgery.

More about laparoscopic surgery
Laparoscopy is a form of minimally invasive surgery. A tiny telescope (laparoscope) inserted through a small incision at the umbilicus (belly-button) lets the surgeon see pelvic organs on a video monitor. Several smaller incisions are made in the abdomen for inserting specially-designed surgical instruments that are used to complete the procedure.

The Procedure
After the patient is given a general anesthesia, a surgeon makes a small incision, usually below or inside the belly-button. A special needle is used to pump carbon dioxide gas through the incision into the abdomen. Inflating the abdomen with gas makes the pelvic organs easier to see. The patient will be lying with her feet higher than her head. This position shifts some of the organs out of the way. A device may also be placed in the uterus through the vagina to move the uterus out of the way during the procedure.

The surgeon removes the needle from the incision and inserts a tube with a valve. The laparoscope is passed through the tube. More incisions are made just at the pubic hairline and in the left and right lower abdomen. Special surgical instruments are inserted through these incisions and used to complete the procedure. When the procedure is finished, the instruments are removed, and the gas is released. The incisions are then closed with steri-strips or dissolvable stitches.

Patients with systemic health problems that may be aggravated by general anesthesia may not be eligible for laparoscopy, especially those patients with diseases of the heart and lungs. Consult an anesthesiologist if there is any uncertainty.
Scarring from previous abdominal surgeries may limit the surgeon’s ability to gain access to the pelvis at surgery.

Risks
Laparoscopy is very safe but there is always a risk when you have an anesthetic. There is also a risk that the surgical procedure could damage an internal organ, such as an intestine, causing leakage or bleeding into the abdomen. Such an injury might cause an infection or require a blood transfusion.

Recovery
After the procedure, you will rest in the recovery room for several hours until the anesthetic has worn off and the clinician has made sure you are able to go home. Most people can go home on the same day they have a laparoscopic procedure.
You will be given instructions for taking care of the incision before you leave the hospital. You may have some bruising around the wound. Most patients need some pain medication right after the procedure, and a prescription for a narcotic will be provided before discharge from the hospital.

Advantages over open surgery
Open surgery requires a large incision in the abdomen to expose the pelvic organs. This large incision slows postoperative recovery. Patients must often stay in the hospital for five days and may need six weeks of convalescence before they can return to normal activities. Risk of infection is higher because body tissues are more exposed.