A laparoscopy is a surgical procedure that allows the surgeon to access the inside of the abdomen and the pelvis.

Laparoscopy is minimally invasive, or keyhole, surgery. The surgeon does not have to make large incisions (cuts) in the skin. This is made possible with an instrument called a laparoscope.

Laparoscope

A laparoscope is a small flexible tube that contains a light source and a camera. The camera relays images of the inside the abdomen or pelvis to a television monitor.

The surgeon makes a minor incision in the skin, passes the laparoscope through the incision and studies the organs and tissues inside the abdomen or pelvis.

The advantages of this technique over traditional open surgery is that people who have a laparoscopy have:

• a faster recovery time,
• less pain after the operation, and
• minimal scarring.

Diagnostic uses

A laparoscopy can be used to help diagnose a wide range of conditions that develop inside the abdomen or pelvis, such as pelvic inflammatory disease (PID) and liver cancer.

Therapeutic uses

Laparoscopies can be used to carry out surgical procedures. Small surgical instruments and devices, such as lasers, can be passed through incisions in the skin to perform procedures such as removing a damaged or diseased organ.

For more information about the diagnostic and therapeutic uses of laparoscopies, see What it is used for.

How common are laparoscopies?

Laparoscopies are very common in certain areas of medicine, including:

• gynaecology (the study and treatment of conditions that affect the female reproductive system), and
• gastroenterology (the study and treatment of conditions that affect the digestive system).

An estimated 250,000 women have laparoscopic surgery for gynaecological conditions each year in the UK.

Safety

A laparoscopy is generally regarded as a very safe procedure. Serious complications as a result of surgery are rare and occur in an estimated 1 in a 1,000 cases.

Possible complications include:

• damage to organs, such as the bladder or bowel, and
• injury to a major artery (blood vessel).

It is often possible to make a diagnosis using non-invasive methods, such as ultrasound, a computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan. However, sometimes the only way to confirm a diagnosis is to directly study the affected part of the body using a laparoscope.

Laparoscopies are now widely used to diagnose many different conditions and investigate certain symptoms. For example, they may be used in cases such as:

• pelvic inflammatory disease,
• endometriosis,
• ectopic pregnancy (a pregnancy that develops outside the womb),
• female infertility, and
• unexplained abdominal or pelvic pain.

A laparoscopy can also be used to diagnose certain types of cancers. In such cases, the laparoscope is used to obtain a sample of suspected cancerous tissue so that it can be sent to a laboratory for testing. This is known as a biopsy.

Cancers that can be diagnosed using a laparoscopy include:

• liver cancer,
• pancreatic cancer,
• ovarian cancer,
• cancer of the bile duct, and
• cancer of the gall bladder.

Therapeutic laparoscopy

Types of therapeutic laparoscopic surgery include:

• removal of an inflamed appendix in cases of appendicitis, where it is thought that the risk of the appendix bursting is high,
• removing the gallbladder, which is often used to treat gallstones,
• removing a section of the intestine, which is often used to treat digestive conditions, such as Crohn’s disease or diverticulitis, that do not respond to medication,
• repairing hernias,
• repairing bleeding stomach ulcers,
• carrying out a female sterilisation,
• treating ectopic pregnancy (it is usually necessary to remove the embryo to prevent damage to the fallopian tubes),
• removing the womb (hysterectomy), which is sometimes used to treat pelvic inflammatory disease (PID), endometriosis and heavy, painful periods, and
• removing some or all of an organ that has been affected by cancer, such as the ovaries, prostate, liver, colon, kidney or bladder.

Preparation

Depending on the type of laparoscopic surgery being performed, you will usually be asked not to eat or drink anything for 6 to 12 hours before the operation.

If you are taking blood-thinning medication, such as aspirin or warfarin, you may be asked to stop taking it a number of days before surgery. This is to prevent excessive bleeding during the operation.

Most people can leave hospital either on the day of the surgery or the following day. You will usually be advised not to drive for at least 24 hours after surgery, so you will need to arrange for someone to drive you home.

The procedure

A laparoscopy is usually performed under general anaesthetic. This means that you will be unconscious throughout the procedure and have no memory of it.

The surgeon will make a small incision (cut) of around 1-1.5cm (0.4-0.6 inches) near your navel (bellybutton).

A tube is inserted into the incision and carbon dioxide gas is pumped through the tube to inflate your abdomen (stomach). Inflating your abdomen allows the surgeon to see your organs more clearly, and gives them more room to work.

A second, small incision will be made so that the laparoscope can be inserted into your abdomen or pelvis. The laparoscope will relay images to a television monitor in the operating theatre, giving the surgeon a clear view of the whole area.

If the laparoscopy is used to carry out a surgical treatment, such as removing your appendix, one or more further incisions will be made in your abdomen. Small, surgical instruments can be inserted through the incision, and the surgeon can guide them to the right place using the view from the laparoscope. Once in place, the instruments can be used to carry out the required treatment.

After the procedure, the carbon dioxide will be let out of your abdomen, the incisions will be closed using stitches and a dressing will be applied.

A diagnostic laparoscopy usually takes between 30 and 60 minutes to perform. A therapeutic laparoscopy can take between 30 and 90 minutes, depending on the type of surgery being carried out.

Recovery

After a laparoscopy, you will feel groggy and disorientated as you recover from the effects of the anaesthetic. Some people experience symptoms of nausea and vomiting. These are common side effects of the anaesthetic and should pass quickly.

You are likely to have symptoms of mild pain at the site of the incisions in your abdomen, so you will be given painkilling medication.

Some of the carbon dioxide gas used to inflate your abdomen can remain inside your abdomen, which can cause symptoms of:

• bloating,
• cramps, and
• shoulder pain, as the gas can irritate your diaphragm (the muscle that you use to help you breathe) which in turn can irritate nerve endings in your shoulder.

These symptoms are nothing to worry about and should pass three to five days after your body has absorbed the remaining carbon dioxide.

Before you leave hospital, you will be told how to keep your wounds clean and when to return for a follow-up appointment or to have your stitches removed (although dissolvable stitches are now often used).

It is usually recommended that you have someone stay with you for the first 24 hours after your surgery. This is in case you experience any problems, such as symptoms that may suggest you have a post-operative infection. Such symptoms could include:

• a high temperature (fever) of 38°C (100.4°F) or above,
• chills, and
• abdominal pain.

If you have had a diagnostic laparoscopy, you will usually be able to resume your normal activities within five days. The recovery period following a therapeutic laparoscopy depends on the type of treatment.

After minor surgery, such as appendix removal, you may be able to resume normal activities within two weeks. Following major surgery, such as removal of your ovaries or kidney due to cancer, the recovery time may be as long as 12 weeks.

Your surgical team can give you more information about when you will be able to resume normal activities.

Minor complications

Minor complications occur in an estimated 1 or 2 cases in every 100 following a laparoscopy. Possible complications include:

• post-operative infection,
• minor bleeding and bruising around the site of the incision (cut), and
• nausea and vomiting.

Major complications

Major complications following a laparoscopy are rare. They occur in an estimated 1 in every 1,000 cases. They include:

• damage to an organ, such as your bowel or bladder, which could result in the loss of organ function,
• damage to a major artery (blood vessel),
• damage to the nerves in your pelvis, which could lead to erectile dysfunction in men,
• complications arising from the use of carbon dioxide during the procedure, such as the gas bubbles entering your veins or arteries, and
• a serious allergic reaction to the anaesthetic.

Further surgery is usually required to treat these major complications.