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Laparoscopy
Gynecological laparoscopy is a minimally invasive surgical method, when a laparoscope instrument with a camera and the instruments used to perform the surgery are inserted into the abdominal cavity through small incisions on the front abdominal wall.
The camera is connected to the monitor that shows the condition in the abdominal cavity.
Advantages of laparoscopy in gynecology
Thanks to the minimally invasive approach, patients can enjoy a faster recovery, a lower risk of complications and minimal, almost imperceptible scars.
Here are the main reasons why laparoscopy is often the first choice for many gynecological surgeries:
- Minor scars and pain
- Shorter recovery and hospital stay
- Faster return to daily activities
Laparoscopy can be diagnostic and operative.
Diagnostic laparoscopy
Diagnostic laparoscopy visualizes the organs located in the pelvis and in the abdominal cavity.
Operative laparoscopy
Operative laparoscopy can be used to:
- take sample of a tissue - biopsy;
- operative treatment of endometriosis;
- hysterectomy – removal of the uterus ;
- laparoscopically assisted vaginal hysterectomy (LAVH);
- removal of ovarian cysts, of the ovaries and of fallopian tubes;
- myoma removal ;
- operative treatment of ectopic pregnancy depending on localization;
- emergency conditions such as bleeding from the ovaries and "twisting " of the ovaries and of the fallopian tubes;
- lifting of uterus, vaginal tip and bladder in prolapse of the genital organs
- Laparoscopic "ovarian drilling" - for the treatment of PCOS and ovulation problems
Laparoscopy at the Gyn-Fertility Clinic Milenković
- The decision on laparoscopy is made after a gynecological, ultrasound, and possibly after radiological examination and laboratory analyses.
- The intervention is performed in the period outside of menstrual bleeding, but in acute situations it is also performed during menstruation, while in menopausal women it can be performed at any time.
- Before the laparoscopy, the patient fills out a detailed questionnaire about her health condition.
- Laparoscopy is performed under general anesthesia. Before the surgery, a doctor's examination by an anesthesia specialist is performed and blood tests are performed.
- If there is a disease or risk factor, it is necessary to perform additional analyses and an examination by a doctor of another specialty, most often an internist.
- The patient receives an antiseptic shampoo in the Clinic, which will be used for showering in the evening and morning before the surgery.
- Laparoscopy is performed in a hospital.
- The patient is admitted to the hospital on the same day, possibly the day before the surgery. 6-8 hours before laparoscopy, the patient stops taking food and liquids.
- Upon arrival at the hospital, the patient goes to the patient room where she prepares to enter the operating room.
- A needle is inserted into the vein so that the patient can receive the necessary medication. If necessary, an antibiotic is given.
- Laparoscopy is performed on the operating table. After receiving general anesthesia, a catheter is inserted into the bladder and the operative field is prepared with an antiseptic solution based on iodine or chlorine.
- First, a 12-15 mm incision is made just below or in the navel itself, and then carbon dioxide is injected into the abdominal cavity with a special needle to separate the internal organs from the front abdominal wall and make room for the surgery.
- After carbon dioxide is injected into the abdominal cavity, a 5-12 mm diameter instrument containing a camera is inserted.
- After that, 2-3 incisions of 5 mm are made on the skin, through which the laparoscopic instruments used for surgery are inserted.
- First, the uterus, ovaries, fallopian tubes, the mucosa of the small pelvis and abdominal cavity, the appendix and the space under the liver and diaphragm are examined in detail.
- Then the surgery is performed depending on the condition being operated on.
- It is often necessary to widen one incision in the anterior abdominal wall to 2-3 cm to remove the excised tissue.
- The tissue that is removed is sent to a pathologist for analysis.
- Laparoscopy lasts from 30-120 minutes, sometimes longer depending on the type of surgery.
- After the surgery is completed, the carbon dioxide is "ejected" from the abdominal cavity, and then the instruments are removed. The skin incisions are sutured with dissolvable sutures.
- The patient goes to the patient room, where she first receives pain-relieving drugs.
- The catheter is removed from the bladder no later than 24 hours after the operation. 2-3 hours after the operation, the patient is first allowed to drink liquid, and then a light meal.
- It is desirable for the patient to start standing up and walking as soon as possible after the surgery.
- Sometimes a blood transfusion is needed.
- The patient is usually discharged from the hospital the day after the operation, if necessary the patient stays longer depending on the general condition. After leaving the hospital, pain relief therapy is advised: Paracetamol tablets 500 mg 2 tablets up to 4 times a day in combination with Brufen tablets 400-600 mg up to 3 times a day.
- Taking a shower is allowed on the same day after the operation, except that it is necessary to change the protective patch that is placed on the place of the incision on the skin.
- Bathing and swimming are not allowed ten days after the operation until the skin wound has healed.
- Physical training and sexual intercourse can be started 7-10 days after the operation, except in the case of hysterectomy, when light training can be started after three weeks, and sexual intercourse six weeks after the operation.
- It is advised to have an exemption from work for up to 7-10 days, depending on how the patient feels.
Potential complications
Complications with laparoscopy occur in less than 1% of cases and can be:
- infection or secretion from small incisions, urinary infections, bleeding during and after surgery;
- injuries to the intestines and urinary tract occur in less than 0.5% of cases.
Expert advice: frequently asked questions
Answered by: Milan Milenković, MD, PhD
How long does recovery take after gynecological laparoscopy?
Recovery after laparoscopy depends on the type of laparoscopic surgery. After diagnostic laparoscopy, examination of fallopian tubes, removal of one or both fallopian tubes, removal of one ovary and biopsy, women can return to daily activities after 7-10 days. After laparoscopic hysterectomy and fibroid surgery, the patient can return to normal activities after 2-4 weeks.
When can I shower after laparoscopy?
You can shower a few hours after laparoscopy, for the first time with the help of hospital staff. It is not recommended to take a bath while the bleeding continues.
When can I train after laparoscopy?
You can start training after 7-10 days if a diagnostic laparoscopy was performed. After laparoscopic hysterectomy, you can start training 3-4 weeks after the operation, but walking and light training without exercises that increase the pressure in the abdominal cavity are recommended.
When can I have sex after laparoscopy?
When to start having sex after laparoscopy depends on the type of laparoscopic surgery. After laparoscopic hysterectomy and surgery of genital organs prolapse, abstinence from sexual intercourse for 6 weeks is advised. After laparoscopic myoma surgery, sexual intercourse can be started after 2-3 weeks, while after other laparoscopic surgeries, that period is 7-10 days.
When is the first check up after laparoscopy?
Check up after laparoscopy is usually done after 3-4 weeks, although the assessment is individual.
How long after laparoscopy can a pregnancy be planned?
Pregnancy planning after laparoscopy depends on the type of laparoscopic surgery. If diagnostic laparoscopy, tubal patency test, removal of one or both fallopian tubes, removal of one ovary and biopsy was performed, pregnancy, either spontaneous or after in vitro fertilization, can be planned already in the next menstrual cycle. After laparoscopic myoma surgery, pregnancy can be planned after 3 months, while after ovarian cyst surgery and laparoscopic "drilling" of the ovaries, pregnancy can be planned after 2-3 months.
How large are the scars on the skin and how to treat them?
Scars on the skin are minimal and no special treatment is required. In case of redness and secretion from the incisions immediately after the operation, the incisions should be rinsed with saline solution. Scars are usually minimal or not noticeable after a few months.
In which acute situations should the Clinic be contacted?
In case of pain, high body temperature and heavy bleeding, you should call 069 50 22222, send a message to info@drmilenkovic.com or contact the nearest emergency department.
If you have additional questions, please feel free to contact us.
You can expect an answer during office hours, from Monday to Friday, between 9 a.m. and 7 p.m.
