Laparoscopy

If you are considering having a laparoscopy or have an operation planned, it is important to know all you can about it. This includes:

• why you need this operation

• what it will be like

• how it will affect you

• what risks are involved

• any alternatives.

The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

What is the problem?

You may be having pain in your lower abdomen and/or your back. You may have a swelling in your pelvis, which has shown up during an examination or on an ultrasound scan. The problem may be coming from your uterus, Fallopian tubes or ovaries.

We need to look inside your abdomen to discover the problem and help decide on the best treatment, if any is necessary.

What are the uterus, Fallopian tubes and ovaries?

To explain where the uterus, Fallopian tubes and ovaries are, and what they do, the best place to begin is the vagina. The vagina is a tube about five inches long. It runs from just in front of the anus up into the pelvis. The vagina is just behind the bladder. Just in front of the vagina the bladder has it’s opening where the urine comes out. This is called the urethra.

The uterus is at the top of the vagina. It is about the size of your clenched fist. It is made of thick muscle and it is hollow. Inside the uterus there is a lining called the endometrium.

The lowest part of the uterus, called the cervix, juts down into the vagina. Cervical smears are taken from the cervix. The main part of the uterus is called the body. At the top of the uterus there are two hollow tubes called the Fallopian tubes. There is one on each side. These end close to the ovaries. Each ovary is slightly smaller than a golf ball. They lie deep in the pelvis just below the waist.

The ovaries make hormones. Each ovary also contains tiny eggs, which are too small to see with the naked eye.

What do the uterus, Fallopian tubes and ovaries do?

The uterus is where a baby develops during pregnancy. About once a month an egg in one of the ovaries grows and breaks free from the ovary. It moves into the Fallopian tube and travels down the tube towards the uterus. At the same time, hormones make the endometrium thicker so that if the egg is fertilised by a sperm it can lodge in the uterus. Often, the egg is not fertilised and it dies. The hormones change and the endometrium also dies and is shed. There is some bleeding from the raw endometrium for a few days. This is a typical period. The cycle then starts again for the next month. If the egg is fertilised it starts making extra hormones. These make the uterus and endometrium grow to take the developing baby.

After the age of about 45 years the ovaries stop making some of the female hormones. Eggs are not released each month. The endometrium is no longer shed. The periods stop. This is called the change or the menopause. The changes in hormones often cause hot flushes and dizzy spells. Sometimes the periods become very heavy during this time.

What has gone wrong?

There are many conditions that can be diagnosed during a laparoscopy. Here we discuss a few of the reasons for needing the examination. Sometimes nothing abnormal is found at the laparoscopy. You should discuss the reasons why you need to have a laparoscopy with your gynaecologist.

Ovarian cyst - The egg growing on the surface of the ovary develops as a cyst, called a follicular cyst, which burst to release the egg. Sometimes the release of the egg goes wrong. The follicular cyst does not burst. Instead, it continues to grow, filling up with fluid and possibly blood. This is called an ovarian cyst. The cyst may also release hormones, which can upset your periods. Sometimes the ovarian cyst and ovary become twisted around the ligament that holds them. This can be very painful and can cut off the blood to the ovary. If the ovary loses its blood supply it may need to be removed.

A cyst on the ovary may be a benign tumour. A common benign cyst is called a dermoid cyst, formed from primitive skin tissues that have been present in your ovary since before your birth. The fluid inside is sebaceous material, like in a blackhead. The cyst often contains hair. Dermoid cysts are often found in young women, sometimes in both ovaries.

Other cysts can be malignant tumours, particularly in older women. Cysts can vary in size from about 3cm to15cm or more, before they are detected.

Endometriosis - In this condition other tissues act as if they are endometrium. The tissue is usually within the pelvis, especially around the ovaries. During each period there is bleeding into the endometriosis tissue. This internal bleeding leads to pain and a local reaction. The local reaction may be a collection of old blood, called a chocolate cyst, or adhesions of the ovaries, which can become stuck to the back of the uterus.

Infections - There may be a general infection in the pelvis. This is called pelvic inflammatory disease, or PID for short. One or both Fallopian tubes can become infected. This is called salpingitis. This may cause pain and adhesions in the lower abdomen.

Other conditions - Some conditions, such as appendicitis or an inflamed lower bowel, may also cause pain and swellings in the pelvis similar to the conditions above.

The aims

The main aim of the laparoscopy is to look inside your abdomen to find out what is going on. We can then decide on the best treatment. During the laparoscopy the surgeon can look at the uterus, the Fallopian tubes and the ovaries. All the surrounding tissues and structures can also be examined. We use a special telescope, called a laparoscope, attached to a camera. Sometimes we can do minor surgery as well as looking, for example, drawing fluid from an ovarian cyst. Other procedures, such as ultrasound, x-rays, blood tests and swab tests, may provide further information to help us diagnose your problem.

The benefits

A laparoscopy gives an excellent view of the pelvis. Once it is clear what the problem is, the best treatment can be started. If the problem is not in the ovaries or uterus, but instead due to an inflamed appendix, for example, another specialist surgeon could be called to deal with this at the time of your laparoscopy.

Are there any alternatives?

You have probably already had other tests to try and find out the cause for your problems. They may have included ultrasound scans, x-rays and CT or MRI scans. These tests can often be used to give us additional information to help in your diagnosis. The direct view through the laparoscope is often the most accurate examination. The laparoscope also allows us to take a biopsy of tissue for examination under the microscope. Unfortunately, a diagnostic laparoscopy requires a keyhole operation with a general anaesthetic. It is for this reason that the other, less stressful tests are usually done first.

Having an open operation with a large wound, called a laparotomy, is not needed unless there are adhesions inside the abdomen from previous infections or operations.

What if you do nothing?

If you do nothing, the cause of your problems will remain in doubt. You may miss out on important treatment. Any problems will usually remain and could seriously affect your future health.

Author: Dr David Hutchon M.R.C.O.G, F.R.C.O.G.  Consultant Gynaecologist.

© Dumas Ltd 2006

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