Laparoscopy is a type of surgery. In “open” surgery, an incision is made in the skin. This means making an incision that can be several inches long in the abdomen. Laparoscopy is a way of doing surgery using small incisions (usually no more than 1/2 inch long). Laparoscopic surgery sometimes is called “minimally invasive surgery.”
Laparoscopic surgery uses a special instrument called the laparoscope. The laparoscope is a long, slender device that is inserted into the abdomen through a small incision. It has a camera attached to it that allows the obstetrician–gynecologist (ob-gyn) to view the abdominal and pelvic organs on an electronic screen. If a problem needs to be fixed, other instruments can be used. These instruments usually are inserted through additional small incisions in the abdomen. They sometimes can be inserted through the same single incision made for the laparoscope. This type of laparoscopy is called “single-site” laparoscopy.
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Laparoscopy can take longer to perform than open surgery. The longer time under anesthesia may increase the risk of complications. Sometimes complications do not appear right away but occur a few days to a few weeks after surgery. Problems that can occur with laparoscopy include the following:
- Bleeding or a hernia (a bulge caused by poor healing) at the incision sites
- Internal bleeding
- Damage to a blood vessel or other organ, such as the stomach, bowel, bladder, or ureters
Tubal sterilization can be done using laparoscopy. Laparoscopy also is one of the ways that hysterectomy can be performed. In a laparoscopic hysterectomy, the uterus is detached from inside the body. It can be removed in pieces through small incisions in the abdomen or removed in one piece through the vagina.
Laparoscopy may be used to look for the cause of chronic pelvic pain, infertility, or a pelvic mass. If a problem is found, it often can be treated during the same surgery. Laparoscopy also is used to diagnose and treat the following medical conditions:
- Endometriosis—If you have signs and symptoms of endometriosis and medications have not helped, a laparoscopy may be recommended. The laparoscope is used to see inside your pelvis. If endometriosis tissue is found, it often can be removed during the same procedure.
- Fibroids—Fibroids are growths that form inside the wall of the uterus or outside the uterus. Most fibroids are benign (not cancer), but a very small number are malignant (cancer). Fibroids can cause pain or heavy bleeding. Laparoscopy sometimes can be used to remove them.
- Ovarian cyst—Some women have cysts that develop on the ovaries. The cysts often go away without treatment. But if they do not, your ob-gyn may suggest that they be removed with laparoscopy.
- Ectopic pregnancy—Laparoscopy may be done to remove an ectopic pregnancy.
- Pelvic floor disorders—Laparoscopic surgery can be used to treat urinary incontinence and pelvic organ prolapse.
- Cancer—Some types of cancer can be removed using laparoscopy.
Laparoscopy usually is performed with general anesthesia. This type of anesthesia puts you to sleep. Regional anesthesia is used instead of general anesthesia in some situations. This type of anesthesia blocks feeling in a region of your body—such as the area below your waist—so that no pain is felt.
After you are given anesthesia, a small incision is made in or below your navel or in another area of your abdomen. The laparoscope is inserted through this small incision. During the procedure, the abdomen is filled with a gas. Filling the abdomen with gas allows the pelvic reproductive organs to be seen more clearly. The camera attached to the laparoscope shows the pelvic organs on a screen. Other small incisions may be made in the abdomen for surgical instruments. Another instrument, called a uterine manipulator, may be inserted through the vagina and cervix and into the uterus. This instrument is used to move the pelvic organs into view.
fter the procedure, the instruments and most of the gas are removed. The small incisions are closed. You will be moved to the recovery room. You will feel sleepy for a few hours. You may have some nausea from the anesthesia. If you had outpatient surgery, you will need to stay in the recovery room until you can stand up without help and empty your bladder. You must have someone drive you home. You usually can go home the same day. More complex procedures, such as laparoscopic hysterectomy, may require an overnight stay in the hospital.
For a few days after the procedure, you may feel tired and have some discomfort. You may be sore around the incisions made in your abdomen and navel. The tube put in your throat to help you breathe during the surgery may give you a sore throat. Try throat lozenges or gargle with warm salt water. You may feel pain in your shoulder or back. This pain is from the small amount of gas used during the procedure that remains in your abdomen. It goes away on its own within a few hours or days. If pain and nausea do not go away after a few days or become worse, you should contact your ob-gyn.
Your ob-gyn will let you know when you can get back to your normal activities. For minor procedures, it is often 1–2 days after the surgery. For more complex procedures, such as hysterectomy, it can take longer. You may be told to avoid heavy activity or exercise.
Contact your ob-gyn right away if you have any of the following signs or symptoms:
- Pain that is severe or gets worse
- Heavy vaginal bleeding
- Redness, swelling, or discharge from the incision
Inability to empty your bladder
There are different types of hysterectomy:
- Total hysterectomy—The entire uterus, including the cervix, is removed.
- Supracervical (also called subtotal or partial) hysterectomy—The upper part of the uterus is removed, but the cervix is left in place. This type of hysterectomy can only be performed laparoscopically or abdominally.
- Radical hysterectomy—This is a total hysterectomy that also includes removal of structures around the uterus. It may be recommended if cancer is diagnosed or suspected.
In some cases, medications or other procedures that allow you to become pregnant now or in the near future can be tried before having a hysterectomy. Some women wait to have a hysterectomy until after they have completed their families. If you choose another option besides hysterectomy, keep in mind that you may need additional treatment later.
Hysterectomy is used to treat many women’s health conditions. Some of these conditions include the following:
- Uterine fibroids (this is the most common reason for hysterectomy)
- Pelvic support problems (such as uterine prolapse)
- Abnormal uterine bleeding
- Chronic pelvic pain
- Gynecologic cancer
Hysterectomy is surgery to remove the uterus. It is a very common type of surgery for women in the United States. Removing your uterus means that you can no longer become pregnant.
One or both of your ovaries and fallopian tubes may be removed if they are abnormal (for example, they are affected by endometriosis). This procedure is called salpingo-oophorectomy if both tubes and ovaries are removed; salpingectomy if just the fallopian tubes are removed; and oophorectomy if just the ovaries are removed. Your surgeon may not know whether the ovaries and fallopian tubes will be removed until the time of surgery. Women at risk of ovarian cancer or breast cancer can choose to have both ovaries removed even if these organs are healthy in order to reduce their risk of cancer. This is called an elective salpingo-oophorectomy.
You will experience immediate menopause signs and symptoms. You also may be at increased risk of osteoporosis. Hormone therapy can be given to relieve signs and symptoms of menopause and may help reduce the risk of osteoporosis. Hormone therapy can be started immediately after surgery. Other medications can be given to prevent osteoporosis if you are at high risk.
Laparoscopic surgery requires only a few small (about one-half inch long) incisions in your abdomen. A laparoscope inserted through one of these incisions allows the surgeon to see the pelvic organs. Other surgical instruments are used to perform the surgery through separate small incisions. Your uterus can be removed in small pieces through the incisions, through a larger incision made in your abdomen, or through your vagina (which is called a laparoscopic vaginal hysterectomy).
A robot-assisted laparoscopic hysterectomy is performed with the help of a robotic machine controlled by the surgeon. In general, it has not been shown that robot-assisted laparoscopy results in a better outcome than laparoscopy performed without robotic assistance.
Compared with abdominal hysterectomy, laparoscopic surgery results in less pain, has a lower risk of infection, and requires a shorter hospital stay. You may be able to return to your normal activities sooner. There also are risks with laparoscopic surgery. It can take longer to perform compared with abdominal or vaginal surgery, especially if it is performed with a robot. Also, there is an increased risk of injury to the urinary tract and other organs with this type of surgery.
No, some women are at greater risk of complications than others. For example, if you have an underlying medical condition, you may be at greater risk of problems related to anesthesia.
You may need to stay in the hospital for up to a day or two after surgery. T You will be urged to walk around as soon as possible after your surgery. Walking will help prevent blood clots in your legs.
Follow your health care provider’s instructions. Be sure to get plenty of rest, but you also need to move around as often as you can. Take short walks and gradually increase the distance you walk every day. You should not lift heavy objects until your doctor says you can. Do not put anything in your vagina during the first 6 weeks. That includes douching, having sex, and using tampons.
After you recover, you should continue to see your health care provider for routine gynecologic exams and general health care. Depending on the reason for your hysterectomy, you still may need pelvic exams and cervical cancer screening.
You can expect to have some pain for the first few days after the surgery. You will be given medication to relieve pain. You will have bleeding and discharge from your vagina for several weeks. Sanitary pads can be used after the surgery. Constipation is common after most hysterectomies. Some women have temporary problems with emptying the bladder after a hysterectomy. Other effects may be emotional. It is not uncommon to have an emotional response to hysterectomy. You may feel depressed that you are no longer able to bear children, or you may be relieved that your former symptoms are gone.