Keyhole Surgery / Laparoscopy

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This describes the type of minimally invasive operation in which Doctors use a viewing telescope (Laparoscope) attached to a Camera and light source to see the inside of the abdomen or uterus.

What is laparoscopic or keyhole surgery?

Laparoscopic or keyhole surgery describes a type of operation in which doctors use a viewing telescope (laparoscope) attached to a camera and light source to see inside the abdomen. Compared to open surgery, laparoscopic surgery offers many benefits which include small skin incisions, better cosmetic scars, less postoperative pain, shorter hospital stay often day-only, faster recovery and earlier resumption of normal activities and employment.
In experienced hands, laparoscopic surgery is a safe alternative to open surgery for the treatment of most gynaecological conditions.

What is laparoscopic surgery used for?

Broadly speaking, the uses of laparoscopy can be divided into two types:

Diagnostic laparoscopy
This involves looking directly at the organs inside the abdomen and pelvis, a Diagnostic laparoscopy may be recommended following non-invasive tests such as x-rays or ultrasound. Being able to inspect the inside of the abdomen directly helps doctors find out the causes for abdominal or pelvic pain, the reasons behind infertility, the nature of pelvic mass or cyst. The information gained allows doctors to make a diagnosis and to help you choose an appropriate treatment for the underlying problem.

Operative laparoscopy
There are many conditions which can be treated via laparoscopy. These include:
– Hysterectomy (removal of the uterus)
– Endometriosis
– Ovarian cysts
– Tubal damage
– Fibroids
– Pelvic floor prolapse
– Urinary incontinence
– Division of adhesions
– Severe period pain
– Certain types of cancer of the uterus, ovary,and cervix

What are the benefits of laparoscopic surgery?

There are a number of advantages of laparoscopic surgery to a patient versus
traditional (open) surgery. These include:

Minimized bleeding during laparoscopy, which reduces the chance of needing a blood transfusion.
Smaller (key hole) incision, which reduces pain and shortens recovery time, as well as resulting in less post-operative scarring.
Less pain, leading to less pain medication needed.
Reduced hospital stay, and often with a same day discharge which leads to a faster return to everyday living.
Reduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections.

What to do before the laparoscopy?

Ensure that you understand clearly the indication for surgery.
Ensure that you have had time to discuss and considerthe risks and benefits of the recommended procedure and that you clearly understand what is going to be done.
Ensure all paper work and admission forms are in order.
Check with the hospital to find out the time you are to be admitted.
Fast for six hours before surgery as laparoscopy requires that you have a general anaesthesia.

What kind of anaesthesia is required for laparoscopic surgery?

With few exceptions, laparoscopic surgery is only carried out under general anaesthesia.

What happens in a diagnostic laparoscopy?

Once general anesthesia is administered, the doctor makes a small incision at the base of the umbilicus through a special gas and the telescope can be introduced into the abdomen. The abdomen is then inflated with gas, this helps to expand the abdominal cavity making it possible to see abdominal and pelvic organs clearly. sometimes another small incision is required to allow the doctor to hold and thoroughly inspect the various organs.

What happens in an operative laparoscopy?

Operative laparoscopy is a procedure doctors set up to remove a disease for example fibroid endometriosis, or to repair blocked fallopian tubes. This generally requires doctors to make two or more small incisions in order to operate with specially designed thin long instruments.

Post operative care Wound care

The Laparoscopic sites will have stitches that dissolve and be covered with small paper tapes (steristrips).
The waterproof dressings are to be removed two days after your operation.
Keep the sites clean and dry. You may remove the steristrips after five to six days.

Post-operative symptoms

Expect some soreness and pain around the incision sites for several days. you may also experience some shoulder tip or rib cage pain. This is due to a small amount of residual gas under the diaphragm. peppermint tea, paracetamol and a hot pack applied for a short time to the painful area may be helpful. anti- inflammatory medication may be required.
Abdominal bloating will settle over the next few days.
You may have vaginal bleeding and spotting or discharge for up to a week following surgery. Sanitary pads are to be used, not tampons. Activities You should avoid vigorous activities for the first week after your operation.
Increase your physical activities over the next few weeks.
Avoid exercises such as sit-ups or lifting heavy objects until after your first post-operative review.
You may resume sexual intercourse three weeks following surgery unless your doctor states otherwise.
You may need one to two weeks off work. This varies depending on your work activities and the type of surgery performed.

Benefits of Laparoscopic Surgery

Minimized bleeding during laparoscopy, which reduces the chance of needing a blood transfusion.
Smaller (key hole) incision, which reduces pain and shortens recovery time, as well as resulting in less post-operative scarring.
Less pain, leading to less pain medication needed.
Reduced hospital stay, and often with a same day discharge which leads to a faster return to everyday living.
Reduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections.

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