Pelvic Laparoscopy

Doctors use many imaging techniques to observe pelvic abnormalities. These techniques include ultrasound, CT scan, and MRI. Your doctor may use a pelvic laparoscopy after other noninvasive options have been used. The procedure may be able to provide more detail when the data gathered through these other methods cannot provide a definite diagnosis.

Your doctor can use a pelvic laparoscopy to investigate and treat conditions affecting the uterus, ovaries, fallopian tubes, and other organs in your pelvic area. Your doctor may recommend a pelvic laparoscopy to:

• determine the cause of pelvic pain
• examine an abnormality, such as a tissue mass, ovarian cyst, or tumor, which was possibly found in another imaging study
• confirm the presence of endometriosis, which is a condition in which cells from the lining of your uterus grow outside of your uterine cavity
• diagnose a pelvic inflammatory disease
• examine your fallopian tube for obstructions or ectopic pregnancy
• investigate conditions that might cause infertility
• observe the extent of ovarian cancer, endometrial cancer, or cervical cancer

Your doctor can take a biopsy of the abnormal tissue during a pelvic laparoscopy. They can also use the procedure to diagnose and treat specific conditions.

Using the video monitor as a guide, your doctor can:

• obtain a tissue sample for biopsy
• eliminate scar tissue or abnormal tissue from endometriosis
• repair a damaged uterus
• repair damage to your ovaries or fallopian tubes
• remove an ectopic pregnancy
• perform an appendectomy
• perform a hysterectomy, or removal of the uterus
• perform a tubal ligation, which is sterilization of your fallopian tubes
• remove lymph nodes affected by pelvic cancers

You usually will prepare for a laparoscopy in much the same way that you would for any other surgical procedure.

You should tell your doctor about any prescription or over-the-counter medications that you’re taking. Your doctor can discuss how these medications should be used before and during the test.

Certain medications could affect the outcome of your laparoscopy. Therefore, your doctor may provide special instructions if you’re taking any of the following:

• anticoagulants, or blood thinners
• nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin or ibuprofen
• medications that affect blood clotting
• herbal or dietary supplements

Tell your doctor if you’re pregnant or think you might be pregnant. This will ensure that your fetus isn’t harmed during the procedure.

Your doctor may request an additional imaging study, such as an ultrasound, CT scan, or MRI before surgery. The data from that imaging study can help them better understand the abnormality they’re investigating. The imaging results can also provide your doctor with a visual guide to your pelvic region, improving effectiveness.

You cannot eat or drink anything (including water) for at least eight hours before your laparoscopy. If you smoke, you should try to quit. Ask a friend or family member to drive you to the surgery if your doctor gives you a sedative to take at home before the procedure. The sedative will impair your ability to drive.

A pelvic laparoscopy can be done in a hospital, but it’s usually performed in an outpatient clinic.

Before surgery, you’ll be asked to change into a hospital gown. An intravenous line will be inserted into your hand or arm. You’ll get general anesthesia in most cases. This will allow you to remain in a deep sleep and not feel any pain during the procedure.

In other cases, you’ll get a local anesthetic. This type of anesthesia prevents you from feeling pain in your pelvic area during the procedure. However, it will not put you to sleep. You may feel a pricking or burning sensation when your doctor injects local anesthesia into your pelvis. You may still feel pressure from the laparoscope during the procedure, but you shouldn’t feel pain.

Your doctor will make a small cut above your navel about one-half inch long once the anesthesia has taken effect. A narrow, tube-like instrument called a “cannula” will be placed into your abdominal cavity to expand the cavity with carbon dioxide. This makes room in that area for your doctor to work. It also allows for a clearer view.

They’ll then insert the laparoscope through the incision near your navel. Up to four dime-sized cuts will be made closer to your pubic hairline. These cuts allow space for additional cannulas and other tools that will be needed to perform the procedure.

Your doctor may also insert a uterine manipulator through your cervix into your uterus. This will help move the pelvic organs into view. Your doctor will remove the instruments and gas from your body and will close all of your incisions once surgery has been completed. Bandages will be placed over the stitches used to close your incisions.

You’ll need to remain in the outpatient facility or hospital for recovery and observation before you can be released. Doctors and nurses will monitor your vital signs, including:

• blood pressure
• temperature
• pulse
• breathing rate

The amount of time that you’ll need to stay in the recovery area will vary depending on your overall physical condition, the type of anesthesia that was used, and your body’s reaction to the procedure. In some cases, you may need to remain in the hospital overnight.

You’ll be discharged once the effects of your anesthesia have worn off. However, you won’t be permitted to drive yourself home after the procedure. Have someone accompany you to the procedure, so that they can drive you home.

After your pelvic laparoscopy:

• You may feel slight pain and throbbing at the surgical sites.
• You may have abdominal bloating or discomfort from the carbon dioxide for up to two days. The level of pain or discomfort should decrease each day.
• It’s not uncommon to have shoulder pain after your procedure. This occurs when the carbon dioxide gas causes an irritation in your diaphragm, which is a muscle that shares nerves with your shoulder.
• You may have a sore throat from the breathing tube used during the procedure.

Your doctor may prescribe medication to relieve the pain.

Every person reacts differently to the procedure. Follow your doctor’s discharge instructions about when to resume normal activities, such as going to work and doing physical activities. Your post-surgical instructions will depend on the type of procedure you had.

You’ll be instructed not to lift any heavy objects for about three weeks after the procedure. This will reduce your risk of developing a hernia in one of your incisions. You can resume your normal diet. You’ll need to return to your doctor in about two weeks for a follow-up visit.

Pelvic laparoscopy is considered a surgical procedure. The most common complications are bleeding and infection. However, these risks are minimal. Still, it’s important to be aware of signs of infection.

Contact your doctor if you have any of the following:

• vaginal bleeding
• a menstrual flow that’s unusually heavy or filled with clots
• abdominal pain that increases in intensity
• chills
• fever
• redness, swelling, bleeding, or drainage at your incision sites
• continued nausea or vomiting
• shortness of breath

A pelvic laparoscopy includes a risk of potential internal damage. Your doctor will conduct immediate open surgery if an organ is punctured during the pelvic laparoscopy.

Rare complications include:

• a reaction to general anesthesia
• inflammation or an infection of the abdomen
• a blood clot that could travel to your pelvis, legs, or lungs
• a blood clot that could enter your heart or brain
• the need for a blood transfusion or temporary colostomy

The doctor who performed your pelvic laparoscopy will analyze the findings. If a biopsy was taken, a specialist in disease diagnosis called a “pathologist” will examine it in a laboratory. A pathology report detailing the results will be sent to your doctor.

Normal results of a pelvic laparoscopy indicate that the reproductive organs and any other organs examined are normal in size and appearance. A normal report also documents the absence of cysts, tumors, or other abnormalities in the pelvic area.

Abnormal laparoscopy results can indicate any one of numerous conditions including:

• adhesions or surgical scars
• uterine fibroids, which are benign tumors
• cancer
• cysts or tumors
• endometriosis, which occurs when tissue from the inside of your uterus grows outside of your uterus
• hernias
• injury or trauma
• obstruction in your fallopian tube
• ovarian cysts
• pelvic inflammatory disease

Your doctor may need to order more laboratory tests and perform more physical exams before they’re able to give you a diagnosis.