Laparoscopy Overview

What is laparoscopy?
Laparoscopy (pronounced: lap–a–ros–co–pee) is a (minimally invasive) type of endoscopy procedure. This procedure will allow your doctor to look inside your abdomen (belly) using a thin surgical telescope that has a small lens on the end of it.

Why is a laparoscopy done?
A laparoscopy is done to determine the cause of pelvic pain, so it can be treated. Because this is a surgical procedure, it’s most often performed if other tests haven’t been helpful in finding the reason for your pain. It can also be used to remove an ovarian or tubal cyst.

How is a laparoscopy done?
In an operating room at Boston Children’s Hospital, an anesthesiologist will help you go to sleep with general anaesthesia. After you’re asleep, your surgeon will make 2–4 very small “incisions” (cuts in the skin) about ¼ of an inch long in your abdomen. The first incision is placed just inside your belly button. Your surgeon will put carbon dioxide gas into your abdomen through this incision. The gas makes room inside your abdomen so your internal organs can be seen. Next, the surgical telescope will be placed into the first incision. A surgical telescope is a long instrument that looks like a thick straw. At the tip of the telescope is a lens. The lens projects an image of the inside of your abdomen through a fiber optic cable on a small screen (like a television). The other incisions (1–3) are made just above your pubic bone. Special laparoscopic instruments are placed into the lower incision(s).

What can my surgeon see?
Your surgeon will be able to see the outside of the organs in your pelvic area including your uterus, ovaries, fallopian tubes, bowel, bladder, appendix, and area behind the uterus called the cul–de–sac. He/she will also be able to see other problems such as appendicitis, or ovarian or tubal cysts, if you’re extremely constipated, growths or tumors, and endometriosis. Any visible endometriosis can be removed or destroyed during the procedure, and ovarian or tubal cysts can be drained, removed, or destroyed.

How is the endometriosis destroyed?
Surgical treatment using different methods is aimed at removing and/or destroying any visible endometriosis lesions. Superficial lesions (lesions that are just on the surface and don’t go deep into the tissues) are treated at the time of laparoscopy by surgical excision (cutting them out) or burning them off. Other medical terms that describe the destruction of endometriosis are “ablation, vaporization and fulguration” which are used with different kinds of energy sources. However, both excision (surgical removal) and destruction/ablation techniques are equally effective with improving pain symptoms for Stage I and II endometriosis.

• Burn–off is the treatment of choice for superficial endometriosis. This is done with high heat. Heat can be generated by a number of sources–electricity (cautery), ultrasound (Harmonic scalpel), or laser. All energy sources have been shown to be equally effective in destroying endometriosis lesions. Ablation/fulguration of ovarian tissue during laparoscopy isn’t recommended.
• Surgical excision is the most common and effective treatment for endometriosis of the ovary (endometrioma cyst). Surgical removal at the time of laparoscopy has been shown to improve pain without damaging the ovaries. Deeply infiltrating disease (Stage III and IV) which is less common in adolescent is best excised.

What are the chances that I could have endometriosis?
If you have had chronic pelvic pain (also called CPP—pain that persists longer than 2–3 months) and it’s not relieved with oral contraceptives and nonsteroidal anti–inflammatory medication, you may have endometriosis. A research study done at Boston Children’s Hospital found that endometriosis was the most common cause of chronic pelvic pain (in adolescents), affecting greater than 70% of girls that did not respond to medical treatment for dysmenorrhea (painful periods).

How long will the surgery take?
Day surgery procedures usually take less than one hour. However, when you wake up from the anesthesia, it will seem like you were asleep for just a couple of minutes.

What type of stitches will I have?
Your surgeon uses stitches that dissolve and get absorbed by your body, so you don’t need to have any stitches removed. You may see stitches (tiny pieces of thread) coming out of the skin (this is okay); it doesn’t mean they are coming undone. Most incisions look red or dark pink after the stitches dissolve, but fade over time.

What type of bandages will I have?
You’ll have a small adhesive bandage on each incision. You can remove them two days after your surgery. However, it’s helpful to keep a clean bandage on until the incisions heal (so that your clothing won’t rub against them).

How will I feel after surgery?
While you’re asleep, your surgeon will put numbing medicine in the area around your incisions to lessen any discomfort you may have when you wake up. Some young women may still experience soreness around the incisions. Even though most of the gas used to inflate your abdomen is removed, you may feel a little bloated. Gas often becomes trapped under the diaphragm, which may cause pain in your shoulder. Placing a heating pad against your shoulder usually helps. The GYN team will give you a prescription for pain medication to take if you need it, but in general, the only things that help the shoulder pain are getting up and walking around, applying heat to the area, and time.

Updated: 6/11/2013