Gynaecological laparoscopy: what is it and when should it be performed?

By Cristiano Antonino On Jan 12, 2023

Laparoscopy is a technique that allows you to ‘see’ inside the abdomen, through an instrument called a laparoscope

This is a thin, rigid tube equipped with optical fibres, through which light travels, which is introduced into the abdomen through a small incision near the navel.

Other parts connected to the laparoscope make it possible to perform ‘sky surgery’.

When laparoscopy is indicated

Laparoscopy is recommended as a diagnostic procedure to determine whether the pelvic pain reported by the woman is a result of: endometriosis, pelvic inflammatory disease, extrauterine pregnancy.

It also makes it possible to define whether a pelvic tumescence is a liquid or solid cyst connected to the ovary, or a fibroid or myoma in the uterus.

Laparoscopy also makes it possible to detect an infertility problem, e.g. the presence of adhesions or malformations of the internal genital apparatus

In addition, the chromatographic test is used to check whether the tubes are open or closed.

This test consists of injecting dye (methylene blue) through the uterus and then observing through the laparoscope the passage of the dye through the tubes and its escape into the abdominal cavity.

It is envisaged as a surgical technique in many pathologies: endometriosis, even in the presence of cysts of various sizes; extrauterine pregnancy, allowing the affected tuba to be preserved with a good restoration of its functionality; ovarian cysts, even of considerable size, in fact, they are first aspirated, then dissected and then removed; uterine fibroids, especially if subserous and pedunculated; pelvic adhesions, with good results in completely freeing the pelvis; urinary incontinence, which can be corrected with various laparoscopic techniques.

Tubal sterilisation is an operation that can be performed laparoscopically through the application of clips.

Laparoscopy requires special preparation: fasting from midnight the day before surgery; bowel cleansing enema; partial trichotomy.

On the day of surgery antibiotic prophylaxis is performed and the patient is asked to empty her bladder.

Anaesthesia is always necessary to allow for better relaxation of the patient.

Therefore the following investigations must have been performed: blood tests, electrocardiogram and chest X-ray.

What happens during laparoscopy

The procedure begins with the introduction of a special instrument called a hysteroinjector into the uterus in order to mobilise it.

Then a small incision is made at the level of the umbilicus, through which gas is introduced into the abdomen with the special Verres needle.

This gas separates the pelvic organs from each other and from the abdominal wall, allowing adequate vision.

Then through the umbilical incision the laparoscope is introduced.

Eventually through small incisions in the lower and lateral wall of the abdomen the instruments necessary to perform surgical acts are introduced.

At the end the laparoscope is removed; the gas leaves the abdomen and the hysteroinjector is removed.

A few stitches are applied to the abdominal incisions and a small bandage is placed to protect the wounds.

Diagnostic laparoscopy takes 15-20 minutes, while operative laparoscopy can take up to an hour or more, depending on the complexity of the procedure.

What happens after the test

After the laparoscopy, the patient may complain of some slight discomfort, which, however, disappears within a few days.

Pain may be felt in the shoulders, back or abdomen: a sensation due to the gas used to distend the abdominal cavity.

Nausea may appear, usually a consequence of the gas used, the manipulation of the intestinal loops, as well as the anaesthesia.

Swallowing discomfort may occur due to tracheal intubation performed to facilitate breathing.

In some cases there is difficulty concentrating in the hours following the operation due to the anaesthesia (activities requiring particular concentration, such as driving a car, should be avoided for 48 hours).