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LAPAROSCOPIC SURGERY WITH POSSIBLE LASER THERAPY

Introduction 

Laparoscopy is a surgical procedure in which the doctor makes small incisions, or cuts, in the lower abdomen in order to insert a special instrument called a laparoscope. The incision(s) is usually made in or near the navel (belly button) and sometimes near the "bikini-line". These generally require only 1-2 stitches.
 
The laparoscope itself is a long, thin, rigid tube equipped with lenses and thin glass fibers along which light travels to "illuminate" internal organs. The telescope portion of the instrument enables the physician to see inside the pelvis and abdomen. Other instruments used with the laparoscope allow the doctor to take photographs, to obtain samples of tissue called biopsies and to perform certain operative procedures using a scissors or a laser. Tubal sterilization is the most common operation that is done by laparoscopy. Other procedures include removal of a tubal (ectopic) pregnancy, ovarian cyst, endometriosis, and hysterectomy.
 
Complications
 
Complications from laparoscopy are very uncommon, but they do sometimes occur. Some of the possible complications of laparoscopy are: bleeding, infection, damage to the stomach and intestines; abnormal air collections underneath the skin and in the chest; ruptures or hernias in the surgical wound and through the breathing muscles (diaphragm); burns of the skin of the belly and inside the belly; damage to the kidneys and urinary system; blood clots in the pelvis and lungs; and allergic reactions to substances used during the procedure. Some of the complications may require major surgery and may result in poor wound healing, scarring, disability and, very rarely, death. Therefore, the benefits and risks of the operation are always weighed to provide the patient with the best chance of successful diagnosis and treatment and the lowest risk of complications. Talk to the physician regarding these risks in your situation.
 
Pre-Operative Care
 
In most cases, you must come to the hospital or ambulatory surgical facility with an empty stomach, so no food or liquids should be consumed after midnight preceding the scheduled surgery day.
 
Anesthesia
 
Your doctor will recommend the method of anesthesia which is felt to be best for you. If general anesthesia is used, an injection and gas are given to induce sleep so that there is no awareness of the procedure. If the laparoscopy is done under local anesthesia, a sedative is usually given first to help you relax. Then an anesthetic is injected at the incision site, to numb it.
 
Surgery
 
After you are asleep, an incision is made in or near the navel. Carbon dioxide gas is introduced into the abdomen through a needle inserted in the incision. The gas separates the organs from each other so that the doctor can get a clear view. Next the table is tilted head downward so that the ovaries, uterus and fallopian tubes can be seen clearly. A hollow sheath is then inserted into the abdomen through the incision and the laparoscope is inserted in the sheath. Your procedure (diagnostic or operative) is then performed. Diagnostic procedures generally take 30-45 minutes. Operative procedures, including laser, can last one or more hours. After the procedure, the scope is removed, the gas is allowed to escape and the incision is closed with 1-2 stitches. You are awakened from general anesthesia and then taken to the recovery room to rest. Generally, you can be discharged home 2-4 hours after the procedure is completed. If you have received general anesthesia, someone else should drive you home. If you have had a prolonged surgery, you may need to stay overnight. Talk to your physician about this.
 
Post-Operative Recovery
 
General: Some discomfort at the incision site and mild pelvic cramping is normal. This usually disappears in several days. Pain may be experienced in the shoulders, neck, or abdomen. This pain is related to the carbon dioxide gas used to inflate the belly and to the operative procedure. General anesthesia may cause a feeling of prolonged drowsiness and nausea. A sore throat may occur if an airway (tube to aid breathing) was inserted during anesthesia.
 
Activity: Activities that require concentration should be avoided for 48 hours after general anesthesia. Gradual but continuous improvement will occur and you may increase activity based on how you feel.
 
Work: You may return to work or school as soon as you feel ready. For advanced laparoscopy (such as for extensive endometriosis or cysts) you will receive 2 weeks off.
 
Diet: If nausea occurs, take only liquids by mouth until it passes. You may resume your regular diet as soon as you feel ready.
 
Sex: Abstain from sexual relations until your post-operative check-up unless otherwise instructed.
 
Wound Care: The incision(s) and stitches may be tender for a few days. Soreness, bruising, and abdominal "puffiness" may last one or more weeks. Keep the wounds as dry and clean as possible and apply 1/2 strength hydrogen peroxide (1 part hydrogen peroxide to 1 part water) and cover with a bandaid or gauze 2 times per day until healed. Do not apply alcohol or soap. Paper or plastic tapes can be removed after one week (if they have not already come off). Take showers instead of baths for the first week. Most stitches dissolve on their own and do not need to be removed.
 
Medication: Most post-operative pain is not severe and may be relieved by such over-the-counter preparations as Tylenol, Nuprin, and Advil. Resume taking any prescribed medications. 
 
If you have severe pain, bleeding that is heavier than a normal period, fever over 101° Fahrenheit for 24 hours or more, or redness, swelling with foul smelling discharge at the incision site, call your doctor's office immediately. 




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