Laparoscopy (Keyhole Surgery)

This information is relevant to you if you are having a laparoscopy for investigation and treatment of:

- Pelvic pain and mild to moderate endometriosis
- Infertility
- Diseases of the ovaries and fallopian tubes
- Adhesions (scar tissues)

If you have been offered a laparoscopy as part of your treatment it means non-surgical alternatives are either not suitable or have failed to adequately solve your problem.

What is a Laparoscopy?

Laparoscopy is a type of surgical procedure that allows the surgeon to see through a slender telescope (laparoscope) that is passed through a small cut in the umbilicus (belly button).

Laparoscopy can be performed to diagnose a problem (diagnostic laparoscopy) or to do certain procedures (operative laparoscopy).

What are the advantages of Laparoscopy?

Compared to conventional “open” procedures, Laparoscopy is less invasive. This is why it is also called “minimally invasive surgery”. Patients who have undergone a Laparoscopy have:

Quicker recovery and shorter hospital stay
Less pain
Smaller incisions on the skin and therefore better cosmetic results
Less scar formation inside the abdomen

What procedures can be done by Laparoscopy?

Most procedures performed for benign conditions can be done through keyhole
surgery. Examples are: treatment of Endometriosis, ovarian cysts, ectopic pregnancy as well as hysterectomy and treatment of fibroids.

Mr. Khazali only performs open procedures (laparotomy) in rare circumstances when it is not safe to consider a minimally invasive route.

What happens on the day?

You will be seen by the anaesthetist, who will ask questions about your health and medical history and will explain the anaesthetics with you. Mr. Khazali will see you too and will answer any questions you may have about the procedure. He will go through a consent form with you that explains the procedure and its risks. If you have received the consent form in the post, please read it carefully and bring it with you to be signed on the day.

How is the procedure performed?

Laparoscopy is done under general anaesthetics. This means you will be put to sleep. A small cut (incision) is made through the umbilicus (belly button) to pass the laparoscope. Further incisions (usually 1 to 3) are made above the bikini line and on the sides to pass the instruments. The number of incisions depends on the procedure. These cuts are usually between 5 and 10 millimetres long.

If there is endometriosis, Mr. Khazali’s preferred method is to treat it by cutting the lesions out (excision). This is thought to be the most effective method of treating endometriosis. For more superficial lesions, applying heat (ablation) may be appropriate.

How long will the procedure take?

Between 1 and 2 hours. It can take significantly longer if the procedure is complex. After the procedure, you will be taken to the recovery area to be closely monitored for a while. When you are fully awake, you will be taken back to your room.

How will I feel right after the operation?

Mr. Khazali injects local anaesthetics around the incisions while you are asleep. You will also be given strong pain killers by the anaesthetist to make you as comfortable as possible. For most women, this is enough to control the pain.

What are the risks?

Like any other surgery, there are potential complications. Mr. Khazali will take great care to avoid these complications. In fact, his personal complication rates are well below internationally acceptable figures (data from personal audits to end 2013) . Despite this, there is a small risk of damage to the bowel, bladder, blood vessels and the ureters (the tubes connecting the kidneys to the bladder). The risk of serious complication is less than 1 in 1000 but can be significantly higher if the disease is close to any of the above organs or if there is scar tissue (adhesion).

If a complication occurs and is recognised, it will be dealt with there and then. This may sometimes require open surgery (with a vertical or horizontal incision on the abdomen).

There is also risk of infection and bleeding. These are usually treated with antibiotics or blood transfusion. Rarely, blood clots can form in legs and lungs after the operation. This risk is reduced if you get out of bed and walk around as soon as you are able.

Serious complications are rare and occur in approximately 1 in every 1000
women . These include injury to important surrounding structures, such
as Bowel, Bladder, Ureters and Blood vessels. These risk is significantly higher if there are adhesions, or if the disease is close to one of the structures above or if you are significantly overweight.
More frequent complications (around 1-3 in 100) include bleeding requiring blood transfusion, infection, clot formation in legs and lungs, shoulder tip pain, wound gaping and wound infection.

When can I go home?

You can go home the same day or the day after your laparoscopy, depending on the procedure performed and depending on how you feel. You will need someone to drive you home.

When will I hear about the findings?

A copy of the operation notes detailing all the findings and the procedure performed will be given to you in the hospital. Depending on the time of your operation, Mr. Khazali will always try to see you to explain the findings in person. If you are too tired or drowsy from the anaesthetics, this may not be possible. Either way, you can always phone his office to arrange to talk to him if you wish.

If he has found anything unexpected or worrying, he will always tell you before you leave the hospital. If any tissue has been sent to be examined under the microscope (histology), the results usually take up to 2-3 weeks to come back.

After you have left the hospital

You may get a small amount of vaginal bleeding for 24 to 48 hours.

You can expect some pain and discomfort in your lower abdomen for the first few days after your operation.

You may also have some pain in your shoulder. This is a common side-effect of the operation. When leaving hospital, you will usually be provided with painkillers. If you are prescribed painkillers which contain codeine or dihydrocodeine, these can make you sleepy, slightly sick and constipated. If you do need to take these medications, try to eat extra fruit and fibre to reduce the chances of becoming constipated.

Washing and showering: You should be able to have a shower or bath and remove any dressings 24 hours after your operation. When you first take a shower, it is a good idea for someone to be at home with you to help you if you feel faint or dizzy. Don’t worry about getting your scars wet — just ensure that you pat them dry with clean disposable tissues or let them dry in the air. Keeping scars clean and dry helps healing.

Resting: You may feel much more tired than usual after your operation as your body is using a lot of energy to heal itself. You may need to take a nap for the first few days. Very often feeling tired is the last symptom to improve.

Getting back to normal: While it is important to take enough rest, you should start some of your normal daily activities as soon as you feel able. You will find you are able to do more as the days pass. If you feel pain you should try doing a little less for another few days.

Lifting: Remember to lift correctly by having your feet slightly apart, bending your knees, keeping your back straight and bracing (tightening or strengthening) your pelvic floor and stomach muscles as you lift. Hold the object close to you and lift by straightening your knees.

Exercise: The day after your operation you should be able to go for a short 10 to 15-minute walk in the morning and the afternoon, having a rest afterwards if you need to. You should be able to increase your activity levels quite rapidly over the first week.

There is no evidence that normal physical activity levels are in any way harmful and a regular and gradual build-up of activity will assist your recovery. Most women should be able to walk slowly and steadily for 30 to 60 minutes by the middle of the first week and will be back to their previous activity levels by the second week.

Driving: You should not drive for 24 hours after a general anaesthetic. Each insurance company will have its own conditions for when you are insured to start driving again. Check your policy.

Before you drive you should be:

free from the sedative effects of any painkillers
able to sit in the car comfortably and work the controls
able to wear the seatbelt comfortably
able to make an emergency stop
able to comfortably look over your shoulder to manoeuvre.

It is a good idea to practise without the keys in the ignition. See if you can do the movements you would need to for an emergency stop and a three-point turn without causing yourself any discomfort or pain.

When you are ready to start driving again, build up gradually, starting with a short journey.

Travel plans: If you are considering travelling during your recovery, it is helpful to think about:

The length of your journey: journeys over 4 hours where you are not able to move around (in a car, coach, train or plane) can increase your risk of deep vein thrombosis (DVT). This is especially so if you are travelling soon after your operation.
How comfortable you will be during your journey, particularly if you are wearing a seatbelt.
Would you have access to appropriate medical advice at your destination if you
were to have a problem after your operation?
Does your travel insurance policy cover any necessary medical treatment in the
event of a problem after your operation?
Are your plans in line with the levels of activity recommended in this information?

Having sex: For many people, being able to have sex again is an important milestone in their recovery. It is safe to have sex when you feel ready. If your vagina feels dry, especially if you have had both ovaries removed, try using a lubricant. You can buy this from your local pharmacy.

Returning to work: Most women feel able to return to work 1 to 3 weeks after a laparoscopy, depending on the procedure performed at laparoscopy.

If you have had a diagnostic laparoscopy or a simple procedure such as a sterilisation you can expect to feel able to go back to work within 1 week. Although you will not be harmed by doing light work just after surgery, it would be unwise to try to do much within the first 48 hours.

If you have a procedure as part of an operative laparoscopy, such as treatment of endometriosis you can expect to return 2 to 3 weeks after your operation. If you feel well, you will not be harmed by doing light work on reduced hours after a week or so. When you go back to work will depend on the type of job you do. If you do heavy manual work or are on your feet all day, you may need longer than someone who can sit down at work. You do not need to avoid lifting or standing after this type of operation but you may feel more tired if you have a physically demanding job.

If you are off work for less than 1 week, you should be able to complete a self-certificate for the time you have been off work. If it is longer than 1 week, you will need to obtain a certificate from the hospital where you had your operation.

If you experience

Burning and stinging when you pass urine or pass urine frequently: this may be due to a urine infection. Treatment is with a course of antibiotics.

Red and painful skin around your scars: this may be caused by a wound infection. Treatment is with a course of antibiotics.

Increasing abdominal pain: if you also have a temperature fever), have lost your appetite and are vomiting, this may be caused by damage to your bowel, in which case you will need to be admitted to hospital immediately.

A painful, red, swollen, hot leg or difficulty bearing weight on your legs: this may be caused by a deep vein thrombosis (DVT). If you have shortness of breath, chest pain or cough up blood, it could be a sign that a blood clot has travelled to the lungs (pulmonary embolus). If you have these symptoms you should seek medical help immediately.

If you develop any of the following, contact us or your GP immediately:
Worsening pain in your abdomen that doesn’t respond to simple pain killers.
Feeling generally unwell, cold and clammy
Developing fever
Nausea and vomiting
Shortness of Breath & severe chest pain
Some pain after your operation is to be expected but this should get better each day.