Laparoscopic Surgery Infertility treatment - IHR Guwahati
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Laparoscopy

What is Laparoscopy Surgery?

Laparoscopic surgery is also called Minimal Invasive Surgery (MIS), Band-Aid surgery, or Keyhole surgery. This is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5 —1.0 cm) as compared to larger incisions needed in traditional surgery procedures. Laparoscopy is a procedure that allows looking directly at the contents of a patient's abdomen or pelvis, including the fallopian tubes, ovaries, uterus, small bowel, large bowel, appendix, liver, and gallbladder. At IHR, most of the advanced surgeries are now performed through laparoscopy.

For which cases laparoscopy is performed (Indications)

  • Removal of ovarian cyst and tumours
  • Treatment of endometriosis/chocolate cyst
  • Myomectomy or Removal of fibroids
  • Hysterectomy (removal of the uterus)
  • Sterilization (tubal ligation)
  • Ectopic pregnancy
  • Lysis of adhesions (Adhesiolysis)
  • Fertility investigation such as tubal studies
  • Diagnosis and treatment of uterine anomalies
  • Tubo-tubal anastomosis (Tuba recanalisation)
  • Creation of neo-vagina
  • Ovarian Drilling for Poly Cystic Ovaries (PCOD/PCOS)

How the test is performed?

Laparoscopy requires admission to the hospital. Usually, it is a daycare procedure. It is performed under general anaesthesia. Under general anaesthesia, a small cut (about 1 cm) is made in the umbilicus (belly button). A special needle is inserted into the abdomen through this cut. Carbon dioxide (CO2) gas is put into the abdomen through this needle. This gas helps to separate the organs and make space inside the abdominal cavity, making it easier for the surgeon to see and operate.

Next, a tube (cannula) is passed through the cut in the belly button. A tiny video camera (Laparoscope) is introduced through this tube. The video camera is used to see the inside of the abdomen on special-monitors. An additional one to three small cuts (3-5 mm are made which allow different laparoscopic instruments to be introduced to perform the Laparoscopic surgery. After the procedure is over the laparoscope and other instruments are removed. CO2 gas is released from the abdomen. The cuts are closed/sutured and bandaged.

Advantages

There are several advantages to the patient with laparoscopic surgery versus an open procedure. These include:

Smaller incision, which reduces pain and shortens recovery time.

Less pain, leading to less pain medication needed.

The hospital stay is less, and often with a same day discharge.

Reduced exposure of internal organs to possible external contaminants thereby reducing the risk of acquiring infections.

Quicker recovery to normal activities.

Fewer chances of post-operative adhesions.

Minimal post-operative discomfort.

Greater cosmetic value with smaller or no cut marks.

Reduced bleeding, which reduces the chance of needing a blood transfusion.

What are the risks?

Laparoscopy is considered to be a low-risk procedure with fewer complications. As full general anesthesia is required, so usual risks relating to anesthesia will be there as in all other surgical procedures. Rarely there is a risk of puncturing other abdominal organs such as the bowel, bladder, or blood vessels. Such complications could lead to immediate open surgery (Laparotomy). Sometimes the Laparoscopy may be difficult technically and the surgeon may not be able to view the pelvis adequatly. Under these circumstances, an open surgical procedure may be done.

The risk of complications increases with more complex laparoscopic surgery. Risk is greater for women who are overweight, who had previous abdominal surgery, or other medical problems.

Prior to Surgery:

  • Diet: Do not eat or drink anything after 1 2.00 midnight the night before surgery. Do not smoke or chew gum after 1 2:00 midnight. If you are currently taking medication, ask if you should stop taking it or should you continue.
  • Bowel Preparation: Instructions regarding this are given during preoperative office visit. Liquid diet for one or two days, purging agent like Peglec on the day prior to surgery along with some medication are usually given as a part of bowel preparation. While unpleasant, this makes laparoscopy easier for the surgeon and minimize the risk of surgical complications from the bowel during your surgery.
  • Bath: The patient must shower or bath the night prior to surgery.
  • Make-up: Nail polish, Mehandi, make-up, and jewelry should be removed the night before surgery.
  • Cloths and accessories: Wear loose-fitting clothes to prevent any unnecessary pressure on the umbilicus on the day of surgery. Glasses, contact lenses, dentures, and jewelry should be removed. Valuables should be left with the person who accompanies you or should be left at home.

What after-effects should I expect?

Nausea, discomfort, and tiredness are not uncommon for the first 1-2 days after Laparoscopic surgery.

Pain may be experienced where the cuts were made. There may be aching of the muscles, shoulder tip, and rib cage pain because of the small amount of gas remaining under the diaphragm. Pain relief tablets should help relieve any discomfort. The pain is usually transient and will disappear in a day or two. Also if you drink either hot water or hot tea with fresh lemon. Heat, massage, and exercise can also help to alleviate this pain.

You may experience period type pain and a few days of vaginal bleeding caused by the instruments, which were attached to your uterus during the surgery.

Sore Throat: You may experience a sore throat. This is caused by irritation from a tube placed in your throat trachea) during anesthesia. It usually lasts for just a few days and can sometimes be helped by throat lozenges. you will remain in the hospital for approximately six hours after the procedure. After you are able to empty your bladder, you will be allowed to go home if you feel alright. If you feel weak or not fit to go, an overnight stay or more may be advised.

Care after Your Surgery At Home:

  • Incision: You will have a one cm incision at your navel and 2 to 3 tiny incisions in the lower part of the abdomen. They may or may not have a suture. They will be covered with small strips of adhesive. These strips may be removed daily and ordinary Band-Aids may be applied following surgery. You should cover your incisions with a light dressing to protect your clothes or to prevent your clothing from rubbing on your incisions.
  • Diet: You must consume only clear liquids (juices, barley, dal, vegetable soup, chicken soup, etc.) until you pass gas flatus or have a bowel movement. At this time, you may begin to advance your diet. Eat light, easily digested food for a few days. In the event that you have not passed gas the morning after surgery and have no nausea, you may try something light to eat, such as a piece of toast. If you are unable to tolerate this, and experience nausea at this time, please call your doctor.
  • Activity: Expect to feel sore and "washed out" for a few days following surgery. Remember to get up and move about, even though you may not want to. Increase your activity gradually during this time. Do not engage in strenuous activity until after your first post-op visit. If you plan to travel, please check with your physician prior to surgery if possible. If an emergency arises and you must travel during the first week of surgery, please notify before you leave. The pain pills do what they are supposed to do, which is to mask your pain. Therefore, you may feel a false sense of wellness due to the pain pills, so even though you feel fine the next day or two, be aware that your body is still recovering and take it easy. Eat and drink carefully. The last thing you will want to do following this type of surgery is choke or cough. Sneezing, laughing, crying, and shivering from the cold may also be uncomfortable. So snuggle up and treat yourself well.
  • Sexual Activity: Sexual activity may be resumed approximately seven days following surgery unless you are told otherwise. However, if you have any pain, vaginal bleeding, or discharge, please do not resume sexual intercourse until these symptoms have subsided.
  • Warning Signs: Please notify if your temperature is above 101° F, if you note increasing redness, swelling, pain, or drainage from your incisions, if you experience frequent urination, burning with urination, or not able to pass urine.