Frequently Asked Questions on Laparoscopy & Hysteroscopy

What are the benefits of laparoscopy?What are the risks of laparoscopic surgery?What are possible complications following laparoscopic surgery?What can I expect immediately following laparoscopic surgery?What is the normal recovery time following laparoscopic surgery?When should you contact the physician after laparoscopy?Can I have other surgery performed at the time of my laparoscopy?Will I have a catheter in my bladder at laparoscopic surgery?What is endometriosis and how is it diagnosed?How is endometriosis treated?Can endometriosis be treated laparoscopically?What is the treatment for ovarian cyst?What are fibroids?Can I have my fibroids removed laparoscopically (myomectomy) rather then having a hysterectomy?Can I have my fibroids removed laparoscopically if they are located inside the uterus (submucosal)?If I would like my uterus removed laparoscopically is this always an option?Does my cervix have to be removed at the time of my hysterectomy?Why would I consider a subtotal hysterectomy rather then a total hysterectomy?What are the other alternatives to hysterectomy?

What are the benefits of laparoscopy?
The recovery time in the immediate post operative period is quicker. Patients often go home after only 23 hours to recover in the comfort of their own home. The small incisions tend to be less painful and patients often need less postoperative pain medication as a result. Fewer wound infections occur. The cosmetic results are also appealing as the scar is limited to three or four skin incisions that are less then one half inch long.

What are the risks of laparoscopic surgery?
The risks are similar for both laparoscopic and open surgery. First and foremost, there is always the possibility that surgeon may not be able to complete the procedure laparoscopically. This may be secondary to unexpected complications or because the surgery cannot be safely performed with a laparoscopic approach. Complications specific to laparoscopy include injury to the bowel, bladder and blood vessels at the time of insertion of the surgical instruments and hernia formation at an incision site. Other complications not specific to laparoscopy include infection, bleeding and deep vein thrombosis (blood clot in the legs). Death is also a potential but RARE complication of any type of surgery.

What are possible complications following laparoscopic surgery?

Wound infection

Bruising

Hematoma formation

Anesthesia-related complications

Injury to blood vessels of the abdominal wall or those of the lower abdomen and pelvic sidewall. Injury to the urinary tract or the bowel

What can I expect immediately following laparoscopic surgery?
Generally, you may experience any of the following symptoms within the first twenty-four to forty-eight hours

Nausea and lightheadedness

Scratchy throat if a breathing tube was used during the general anesthesia

Pain around the incisions

Abdominal pain or uterine cramping

Shoulder tip pain-secondary to the carbon dioxide gas

Tender umbilicus (belly-button)

Gassy or bloated feeling

Vaginal bleeding or discharge (like a menstrual flow)

What is the normal recovery time following laparoscopic surgery?
Recovery depends on the type of procedure you had performed. Most patients feel well within days of surgery. But if major surgery has been performed rest is still required. Most patients will require some form of pain medicine in the immediate postoperative period. A prescription for a narcotic as well as an anti-inflammatory, will be provided prior to discharge. Avoidance of heavy lifting (greater then 10 pounds), jumping and jogging is recommended until 4 weeks postoperatively. Sexual intercourse should also be postponed for 4 weeks. It is preferable not to put anything into the vagina for at least 4 weeks including tampons. The timing for returning to work depends on the procedure performed. Most patients who undergo an ovarian cystectomy or ectopic pregnancy are ready to return to work within 2 weeks. If a hysterectomy is performed, 4 to 6 weeks off work is recommended. The doctor will discuss this with you after surgery and help you make an informed choice.

When should you contact the physician after laparoscopy?
You should not hesitate to call the doctor if you develop any of the following symptoms:

Heavy bleeding from the incisions

Fever or chills

Problems with urination or bowel movements

Heavy vaginal bleeding

Severe or increasing abdominal pain

Vomiting

Redness or discharge from the skin incisions

Shortness of breath or chest pain

Will I have a catheter in my bladder at laparoscopic surgery?
Most patients have a catheter inserted at the time of surgery. This catheter is removed in the operating room or within 6 to 12 hours after surgery. Occasionally, the catheter must be reinserted because the patient is unable to void. If this occurs the catheter is usually removed 24 hours later to give the bladder a chance to recover.

Can I have other surgery performed at the time of my laparoscopy?
Yes. Occasionally two procedures are scheduled at the same time. Hysteroscopy is frequently performed at the same time as laparoscopy. Women may also elect to have another elective surgery performed in combination with their gynecologic procedure. Surgeries that have been performed concurrently have included liposuction, gallbladder removal and breast implants.

What is endometriosis and how is it diagnosed?
Endometriosis is a condition, when the endometrium (the lining of the uterus) is found in other places than the uterine cavity. Endometriotic implants can be found on pelvic sidewall, fallopian tubes, ovaries, bowel, bladder, and less commonly outside of the pelvic cavity. Like the endometrial lining in the uterus, these implants undergo similar changes in response to the cyclic hormonal changes. The implants may swell and bleed every month causing pain. Endometriosis may also lead to cysts and adhesions. This condition is found in approximately 20% of women. The most common symptoms of endometriosis are pain with your period, irregular bleeding and infertility. At the present time there is no simple test for diagnosing endometriosis. The only way to diagnose endometriosis with certainty is by laparoscopy and biopsy. Rarely large endometriotic lesions can be diagnosed by ultrasound.

How is endometriosis treated?
Endometriosis can be treated with medications, surgical excision, or combination of the two methods. You should discuss the treatment options with your gynecologist.

Can endometriosis be treated laparoscopically?
Yes. A laparoscopic biopsy is required to diagnose endometriosis. Endometriotic implants can also be treated laparoscopically with excision or burning. This treatment usually produces more immediate results in terms of pain relief and fertility compared to medical therapy.

What is the treatment for ovarian cyst?
A cyst is a fluid filled cavity. Cysts can often be found in the ovaries. Ovarian cysts are usually diagnosed by pelvic exam or ultrasound. If the cyst is entirely filled with fluid it is called a "simple cyst". Ovarian follicles as they undergo maturation may appear on ultrasound as simple cysts or occasionally as complex cysts. These cysts usually resolve within one to two months. Simple cysts are almost always benign. Removal is indicated if they are bigger than 5-6 cm in diameter or if they cause symptoms. If the cyst contains echogenic structures (shadows by ultrasound) it is categorized as a "complex cyst". Complex cysts can represent endometriosis, infection, benign tumors, and rarely malignancies. It is generally recommended that complex cysts be evaluated laparoscopically and possibly removed. The majority of ovarian cysts can be removed laparoscopically.

What are fibroids?
Fibroids are benign growths of the uterus. They occur in 20 to 25 percent of women. Fibroids are most common in women aged 30 to 40 but may occur at any age. Women may have one fibroid or many fibroids. The size of the fibroid also varies from the size of a small pee to more then 6 inches wide.. Some women may be entirely asymptomatic and others may complain of changes in menstruation, pain, pressure, miscarriages and infertility.

Can I have my fibroids removed laparoscopically (myomectomy) rather then having a hysterectomy?
Yes. Some women may have their fibroids (benign growths on the uterus) excised laparoscopically. This procedure is limited to fibroids that are on the outside of the uterus (Pedunculated) or just under the uterine wall (subserosal). Fibroids that are buried deep in the uterus cannot be removed with this approach. The fibroids are then morcellated (ground) and removed through the small incisions. Occasionally, with resection of a fibroid, the uterine cavity may be entered and suturing is required. This usually can be performed using special laparoscopic instruments but infrequently a small ("mini") pfannensteil ("bikini") incision is made to repair the uterus. Rarely a hysterectomy must be performed because of heavy bleeding or inability to reconstruct the uterus. Sometimes a drug (GnRH agonist) may be used to shrink the fibroid and control bleeding prior to surgery.

Can I have my fibroids removed laparoscopically if they are located inside the uterus (submucosal)?
No. If the fibroids (benign growths on the uterus) are only in the inside of the uterus they cannot be approached laparoscopically. Rather, your physician may recommend a hysteroscopic approach.

If I would like my uterus removed laparoscopically is this always an option?
In most cases the uterus can be safely removed laparoscopically. This is not an option when the uterus is very large (greater then 18 week pregnancy in size). Recovery after laparoscopic hysterectomy is usually quicker than after abdominal hysterectomy. To help you choose the most suitable and safe surgery the doctor will consider all these factors prior to proceeding with a laparoscopic hysterectomy.

Does my cervix have to be removed at the time of my hysterectomy?
No, some women elect to have a subtotal hysterectomy. This simply means that the fundus of the uterus is removed and the cervix is maintained. The uterus is removed with the help of a morcelator (a grinder). This instrument allows the surgeon to remove large uteri through small incisions. Not all women are candidates for a subtotal hysterectomy. A previous history of abnormal pap smears would be a contraindication to this approach. To help you choose the most suitable and safe procedure the doctor will consider all these factors prior to proceeding with a subtotal hysterectomy. All women who undergo a subtotal hysterectomy must still have pap smears performed yearly.

Why would I consider a subtotal hysterectomy rather then a total hysterectomy?
This procedure is often faster, associated with fewer surgical complications and more rapid return to normal activities. There is also some evidence to suggest that there is less disruption of the pelvic floor and, therefore, less pelvic prolapse requiring additional surgery in the future. The cervix may also play a role in female orgasm. Many women request a subtotal hysterectomy in order to retain their cervix for sexual function. It is important to realize, however, that just as many women who have had a total hysterectomy have very normal sexual function.

What are the other alternatives to hysterectomy?
Depending upon your symptoms, there are several different alternatives to hysterectomy. Majority of hysterectomies are performed either doe to abnormal bleeding or fibroids. If you have irregular bleeding and your uterus is not to big, endometrial ablation (destruction of the endometrial lining) can be viable option to hysterectomy (look up section under hysteroscopy). If you have fibroids, a myomectomy (removal of fibroids) may be viable treatment for you. If you have large uterine fibroid, uterine artery embolization may be an alternative to hysterectomy. You should discuss all those issues with your Gynecologist before you decide to have the hysterectomy.