Laparoscopy in gynecologic surgery

This intervention consists of examining under general anesthesia the inside of the abdominal cavity and in particular the genitals (uterus, ovaries, tubes) using a camera of a few millimeters, introduced through an incision at the level of the umbilicus. .
Other infracentimetric incisions are made in the supra-pubic region to introduce fine instruments to perform the surgery.
The first goal of laparoscopy is to establish a diagnosis that makes it possible to look for an abnormality undetectable by other means (endometriosis or adhesions) or to confirm the suspected diagnosis by other examinations (ultrasound or clinical examination). Multiple interventions can be performed by laparoscopy:

  • Unilateral or bilateral oophorectomy, which involves the removal of one or both ovaries. Removing an ovary if the other ovary left in place is normal does not affect the regularity of cycles.
  • Ovarian cystectomy which consists of the removal of a cyst present in the ovary while preserving it.
  • Salpingectomy which consists of the removal of the uterine tube, especially in the event of a blocked tube following an infection (hydrosalpinx) or sometimes during an ectopic pregnancy.
  • Uni- or bilateral adnexectomy. The appendix consists of the proboscis and the ovary located on the same side.
  • Salpingitis or infection of the internal genital organs (uterus, ovaries, tubes): in the face of a suspicion of peritonitis, laparoscopy makes it possible to specify the origin of the infection (appendix, genitals, other …). If an abscess is visualized, surgical drainage of it will speed healing. Antibiotic treatment will be initiated.
  • Ectopic pregnancy or pregnancy located outside the cavity of the uterus (most often in the tube): if GEU is suspected, laparoscopy can confirm this diagnosis. Depending on the location of the GEU, tube preservation may be attempted (salpingotomy) or salpingectomy should be performed. Other locations of GEU are rare but can occur and require specific treatment. Your blood type must be communicated to the doctor.
  • Myomectomy (resection of one or more uterine fibroids)
  • Tubal reanastomosis: re-opening of the tube after tubal ligation (see sheet)
  • Tubal plasty or salpingoneostomy: reopening of a blocked fallopian tube (see file)
  • Hysterectomy: removal of the uterus (see sheet)
  • Prolapse cure (cfr sheet)
  • Lymphadenectomy: excision of lymph nodes located in the pelvis and along the aorta as part of an extension assessment or treatment of gynecological cancers.
  • Endometriosis treatment (cfr sheet)

Duration of the intervention

1 to 3 hours.

Duration of hospitalization

2 to 5 days.

In certain indications, a preoperative hospitalization of 24 hours is proposed in order to carry out an intestinal preparation (antibiotic therapy, laxative, enema) associated with a diet without residue (without fruits and vegetables for one week before the intervention).

Frequency of this type of intervention

More than 1,000 laparoscopies are performed per year in the department.

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Side effects of the intervention

If you have not gone through menopause and the ovaries or at least one ovary is left in place, its function will persist until natural menopause. There will therefore be no symptoms of menopause directly after the procedure.
If you are not menopausal and both ovaries are removed during the operation, it will therefore lead to menopause and you may have manifestations, such as hot flashes, … Replacement medical treatment could be discussed. with your gynecologist.
If you have already gone through menopause, removing your ovaries will not have any particular side effects afterwards.
In the event of bilateral salpingectomy, no spontaneous pregnancy may be possible. If you want to become pregnant, medically assisted procreation such as in vitro fertilization should be discussed with your gynecologist.
In the event of a unilateral salpingectomy, if the tube and ovary on the other side are normal, spontaneous pregnancy may well be considered.
If you have been operated on for a GEU with conservative treatment (salpingotomy), you will be offered a follow-up for the decrease in the pregnancy hormone. This is to check by a weekly blood test that the pregnancy blood test becomes negative again. In the event of unfavorable evolution of the blood test, medical treatment may be instituted. In rare cases, a second surgery is sometimes necessary.

In the event of myomectomy, pregnancy should be avoided for 3 months to allow proper healing of the uterus. If the myomectomy scar is deep or multiple, a cesarean section will be indicated for subsequent pregnancies.

During tubal reanastomosis, a guide will be left in place in the tubes for 48 hours. This guide will simply be removed by a gynecological examination before your departure.

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Risks inherent to the intervention and relevant to the patient

During the operation, the surgical approach may be modified depending on the findings made during the operation. It may sometimes be necessary to open the abdomen when the procedure was planned vaginally or laparoscopically.
Damage to organs in the vicinity of the uterus can occur exceptionally (intestinal wound, wound of the bladder or ureter, blood vessels), requiring specific surgical management.
Internal bleeding is also exceptional and a blood transfusion or blood products may then be necessary.
A hematoma or infection (scar abscess) can occur, most often requiring local care. However, a second intervention to adequately treat these complications may be necessary.
Like any surgery, this intervention can very exceptionally involve a life-threatening risk or serious sequelae.
A preventive anticoagulant treatment is established (drugs, stockings with varicose veins, physiotherapy) is prescribed during the period after the intervention in order to reduce the risk of phlebitis (formation of a clot in one of the veins) or of pulmonary embolism.

After the intervention

The first hours after the operation are often painful and require powerful analgesic treatments. Painkillers are administered preventively according to a pre-established schedule. On request, other painkillers can be administered either intravenously or orally.
Laparoscopy can cause pain in the abdomen which may extend to the shoulders and which generally disappears within 48 hours.
Antibiotics are usually prescribed at the time of the procedure.
This treatment can in particular be continued for several days by the intravenous route and then by the oral route as part of the detection of an infection (salpingitis, peritonitis).
Anticoagulant treatment is prescribed and its duration varies depending on your personal history and the extent of the procedure.
An intravenous infusion in the arm and a drain inside the abdomen are usually left in place after the procedure for a variable duration of 1 to 3 days.
There may be moderate and banal vaginal bleeding during the postoperative period.
Resumption of normal eating is usually done on the first day after the operation.
Hospital discharge is generally scheduled either the same day or 5 days after the operation.
Showers are possible a few days after the procedure but it is recommended to wait a week before taking a bath, 1 to 4 weeks before resuming an activity and 2 weeks before resuming sexual activity.
If after your return home you experience pain, bleeding, vomiting, fever or pain in the calves, it is essential to inform your doctor.
A postoperative consultation is offered either to your surgeon or to your referring doctor.
Following a laparoscopy for salpingitis or GEU, regular and close postoperative follow-up is necessary to ensure the effectiveness of the surgical and medical treatment.

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