Laparoscopy

What can you expect?

Laparoscopy is direct visualization of the peritoneal cavity, ovaries, outside of the tubes and uterus by using a laparoscopy. The laparoscopy is an instrument somewhat like a miniature telescope with a fibre optic system that brings light into the abdomen. It is about as big around as a fountain pen and twice as long.

An instrument to move the uterus during surgery will be placed in the vagina. Carbon dioxide (CO2) is put into the abdomen through a special needle that is inserted just below the navel. This gas helps to separate the organs inside the abdominal cavity, making it easier for the physician to see the reproductive organs during laparoscopy. The gas is removed at the end of the procedure.

Microlaparoscopy a new minimally invasive diagnostic surgical procedure uses telescopes and instruments that are much smaller than normal. If this procedure is appropriate for your condition, smaller incisions will be made and postoperative abdominal tenderness may be reduced.

Prior to Surgery

Please refer to your ambulatory surgery centre folder for specific information as to date, time, location, and preparation for surgery.

Arrangements should be made for child care outside the home for the day of surgery and possibly the next day. A quiet, restful environment is needed when you return home. Make arrangements for someone to be there with you for at least 48 hours after surgery. Expect your first night to be restless.

You may wish to have the following items at hand to avoid having to send someone out after your surgery: prescription pain medication, heating pad, over-the-counter pain medications (tylenol, aspirin, aleve, etc.), food (oatmeal, ice cream, rice, steamed vegetables, bread, fruit, yogurt, soup and saltine crackers may be easier on the stomach), thermometer, feminine pads, loose comfortable clothing to wear, throat lozenges, and a good book or video to watch while resting.

Do not eat or drink anything after 12:00 midnight the night before surgery. Do not smoke or chew gum after 12:00 midnight. If you are currently taking medication, ask your doctor if you should stop taking it.

Bowel Preparation: You may be given instructions regarding this during your preoperative office visit. Bowel preparation is usually recommended for patients with endometriosis, pelvic adhesions or pelvic pain. Preparing the bowel with a purging agent such as Go-lytely or Magnesium Citrate is often followed by an oral antibiotic and enemas. While unpleasant, this procedure minimizes the risk of surgical complications from bowel injury during your surgery.

Patient must shower or bathe the night prior to surgery.

Vaginal Prep: None is usually required.

Nail polish, make-up and jewellery should be removed the night before surgery.

Wear loose-fitting clothes to prevent any unnecessary pressure on the umbilicus on the day of surgery.

Immediately Before Surgery

After you check in at the Ambulatory Surgery Centre, the nurse will call you into the changing room. You will take off all your clothing and put on a patient gown, robe and slippers. The nurse will complete a questionnaire about medications, allergies, your health status and other information prior to your surgery. Please ask any questions and express any concerns you may have.

Immediately prior to surgery, you will be asked to empty your bladder. Glasses, contact lenses, dentures and jewellery should be removed. Valuables should be left in the safekeeping of the person who accompanies you or should be left at home.

In the Operating Room

The anaesthesiologist or one of the nurses will walk you into the operating room. The nurse anaesthetist or anaesthesiologist will place four adhesive tabs on your back or on your chest to monitor your heart rate. While watching the monitor, do not be alarmed about sudden changes in your heart rate or pattern. This may be caused by interference and are not related to your heart activity.

You will be given medication that will make you drowsy and possibly make your vision blurry. Shortly after this, you will drift off to sleep.

After Surgery

After surgery, you will wake up in the recovery room. The nurse will check your blood pressure, pulse and temperature frequently. The nurse will check your dressing and intravenous. If you are cold, ask for an extra blanket. The nurse or physician will tell you when you will be allowed to drink something.

As soon as you are transferred from the Recovery Room (about one hour after surgery), you may have visitors. You may not remember conversations immediately after surgery, which is normal and lasts only a short period.

Your physician will discuss the findings with your family immediately after the surgical procedure is complete. If your family leaves the waiting area please have them notify the receptionist regarding how they can be contacted.

Medication will be available for pain or nausea. Ask your nurse for this medication if you are uncomfortable. Medication will be in the form of injections until you are able to drink. Once you are able to drink, the doctor will change your medication to pills. Pain medication is usually allowed every 3-4 hours. Medication for nausea is usually allowed every 4-6 hours. Sore Throat: You may experience a sore throat. This is caused by irritation from a tube placed in your throat (trachea) during anaesthesia. It usually lasts for just a few days and can sometimes be helped by throat lozenges.

You will remain in the Outpatient Surgery Centre for approximately three or four hours after the procedure. After you are able to empty your bladder, you will be allowed to go home. If additional medications are required, you will be given prescriptions to take with you. If you are unable to empty your bladder or nausea is severe, a 23 hour hospital stay overnight may be considered.

Care After Your Surgery At Home

Incisions - You will have a 1/2" incision just below your navel. This incision will have one suture which will dissolve. You will have 2 to 4 tiny (1/4") incisions near the pubic hair line. These incisions accommodate the instruments needed to perform the surgery. They may or may not have a suture. They will be covered with small strips of adhesive. These strips may be removed two or three days following surgery.

You may have drainage from these incisions for a day or two. It will be watery and pink-tinged. If needed, you may reinforce your dressings or change them if they become saturated. In most cases, this drainage lasts less than 48 hours. You may go without dressings 48 hours after surgery if you so desire. You may want to cover your incisions with a light dressing to protect your clothes or to prevent your clothing from rubbing on your incisions. If you have had a micro laparoscopy no sutures will be used and bandaids can be removed the next morning.

Diet

You may be given specific instructions regarding diet prior to leaving the hospital. In general, you must consume only clear liquids (juices, Jello, or both) until you pass gas from you rectum or have a bowel movement. At this time, you may begin to advance your diet. Eat light, easily digested food for a few days.

In the event that you have not passed gas the morning after surgery AND have no nausea, you may try something light to eat, such as a piece of toast. If you are able to tolerate this, you may then begin advancing your diet very slowly. If you do experience nausea at this time, please call the office and speak either with the physician or with the nurse.

Activity

Expect to feel sore and "washed out" for a few days following surgery. Remember to get up and move about, even through you may not want to. Increase your activity gradually during this time. For a week or two after surgery expect to tire easily even after the slightest effort of work or exercise. Do not engage in strenuous activity until after your first post-op visit at our office. If you plan to travel, please check with your physician prior to surgery if possible. If an emergency arises and you must travel during the first week of surgery, please notify our office before you leave.

The pain pills do what they are supposed to do, which is mask your pain. Therefore, you may feel a false sense of wellness due to the pain pills, so even though you feel fine the next day or two, be aware that your body is still recovering and take it easy. Eat and drink carefully. The last thing you will want to do following this type of surgery is choke or cough. Sneezing, laughing, crying and shivering from the cold may also be uncomfortable. So snuggle up and treat yourself well.

Gas Pains

You may experience some gas pains from residual carbon dioxide that may remain in your abdomen following the procedure. This pain usually presents as shoulder pain or sharp pain underneath your diaphragm. The pain is usually transient and will disappear in a day or two. It helps if you get up and move around while you are having this pain, and also if you drink either hot water or hot tea with fresh lemon. Heat, massage and exercise can also help to alleviate this pain.

Infection

Take your temperature every morning for one week. Please notify our office if your temperature is above 101 degrees. If you note increasing redness, swelling, pain or unusual drainage from your incisions, please call our office. If you experience frequent urination, burning with urination, or spasmodic pain in the lower abdomen above the pubic bone, you may have a bladder infection.

Please notify our office if you have any of these symptoms.

Sexual Activity

Sexual activity may be resumed approximately two to three days following surgery unless you are told otherwise. However, if you have any pain, vaginal bleeding, or discharge, please do not resume sexual intercourse until these symptoms have subsided.

This information is not intended as a substitute for medical advice of physicians. The reader should regularly consult a physician in matters relating to his or her health and particularly with respect to any symptoms that may require diagnosis or medical attention.