Operative Laparoscopy and Hysteroscopy
Overview of the Procedure
Laparoscopy is a surgical technique by which many gynecology procedures can be performed. This procedure is done under general anesthesia, therefore you will not be awake during the surgery. The procedure involves making two or more small incisions in the abdomen. The incisions are usually about one half inch in length. One incision is made at the umbilicus (navel). Another incision is usually made just above the pubic bone at the top of the pubic hairline. One or more incisions may be made lateral to this in the lower part of your abdomen. A small needle will be inserted into the umbilical incision and your abdomen will be filled with gas (carbon dioxide). A laparoscope will be inserted through this incision to view your pelvic organs. Surgical instruments will be placed through the incisions in your lower abdomen to perform the indicated surgical procedure.
Laparoscopy is generally a safe procedure, but there are certain risks that you need to be aware of prior to undergoing this procedure. Bleeding and infection are risks of any surgery, and as such may occur after laparoscopy. Injury to intra-abdominal or pelvic organs may occur during laparoscopy. This would include injury to your intestines, bladder, blood vessels or female reproductive organs. Injury may occur during insertion of the needle used to insufflate your abdomen, during insertion of the laparoscope and accessory instruments, or it may occur during the actual surgical procedure. Should an injury occur, it would need to be repaired. Sometimes this can be performed laparoscopically, however, other times it may require a laparotomy (larger incision on your abdomen) to repair the damage. Injuries that are recognized at the time of surgery are repaired immediately. However, some injuries may not be recognized at the time of surgery, but may become apparent several days to a week later. A second surgical procedure may be required at this time to repair the injury. The chance of this occurring is low, but these are recognized risks of laparoscopic surgery.
In addition to the surgical risks, there are risks from the anesthesia, which will be discussed with you in greater detail by the anesthesiologist.
What to Know Before the Surgery
You should not eat or drink anything after midnight on the evening prior to your surgery. You will be instructed on the time to arrive at the hospital and the location of your surgery. If a bowel prep is necessary your physician will instruct you on this prior to the surgery. You should not eat a heavy meal on the day prior to surgery. Someone will need to take you home after the surgery, as you will not be able to drive for several days. Patients are usually discharged home the same day of the surgery. Occasionally, patients will need to be hospitalized overnight for observation. Should any of the above mentioned complications occur then several days of hospitalization may be required.
After the Surgery
Your skin incisions will be covered by a dressing which you may remove the following day. You should keep the incisions clean and dry for 48 hours. After that you may take a bath or shower. The incisions will be closed with sutures which will dissolve. It is common to have shoulder pain the day after surgery. This is due to carbon dioxide gas that is trapped underneath your diaphragm. This should resolve after 1-2 days. You can expect to have some vaginal bleeding for several days after the surgery
You should call your physician immediately if you develop any of the following symptoms: fever greater than or equal to 101 degrees F , abdominal distention (swelling), persistent nausea and vomiting, heavy vaginal bleeding, fainting episodes or severe pain unresponsive to the pain medication you were prescribed. During the daytime you should call our office at (501) 801-1200. On the weekends or at night you should page the on-call physician at (501) 663-8400. You should make an appointment for a post-operative office visit 2-3 weeks after your surgery.
Operative hysteroscopy is a surgical procedure to treat diseases of the uterine cavity. The surgery is usually performed in a hospital operating room under general anesthesia (patient is asleep). The cervical canal is dilated and a surgical instrument called a hysteroscope is inserted into the uterine cavity. A camera is attached to the hysteroscope and the picture is projected onto a television monitor in the operating room. The uterus is then distended with fluid so the surgeon can see inside the uterus. Various instruments can be passed through the hysteroscope to treat diseases of the uterine cavity. Depending upon the nature and extent of the disease being treated, the procedure can take from 30 minutes to several hours to complete. Patients are usually discharged home the same day of the surgery. Operative hysteroscopy is usually performed in the first half of your cycle, i.e. before ovulation. Your physician may place you on hormones to suppress ovulation before this procedure.
Endometrial polyps and uterine fibroids can be removed using the hysteroscope. These are common causes of abnormal uterine bleeding and sometimes can be associated with infertility. Intra-uterine adhesions (scar tissue) can form after a previous dilation and curettage (D&C). These adhesions can be associated with infertility and recurrent miscarriages. The hysteroscope is used to remove these adhesions. Congenital malformations of the uterine cavity, such as a uterine septum, can be treated with the hysteroscope. Fallopian tubes that are blocked at their insertion into the uterine cavity (proximal occlusion) can sometimes be opened by placing small wires through the hysteroscope and into the tube (see fallopian tube catheterization). Tubal sterilization can also be performed through the hysteroscope by placing small metal coils into the opening of the fallopian tubes (see Essure procedure).
There is a small risk of perforating (making a hole) the uterus either during the cervical dilatation or during the hysteroscopy procedure. If this happens, your doctor may need to place a laparoscope into your pelvis to check for injury to adjacent organs. The risk of uterine perforation is low. The fluid used to distend your uterus can also cause complications if you absorb too much of it. Your physician will discuss these risks with you in detail before you have the surgery.
You can expect to have some cramping and light bleeding for several days after the surgery. You will be given pain medicine to take for this. You should call your physician if you have a temperature greater than or equal to 101 degrees Fahrenheit or if you experience bleeding equal to or greater than a normal menstrual period. A follow up appointment will be made in your doctor’s office two weeks after the surgery.