Pelvic laparoscopy: Purpose, Preparation, Procedure, Risk and Results


A laparoscope is used to examine your reproductive organs during a pelvic laparoscopy.

September 7, 2018

A laparoscope is used to examine your reproductive organs during a pelvic laparoscopy. A laparoscope is a long, thin tube with a high-intensity light and high-resolution camera.
Your reproductive organs can be examined without performing open surgery. Pelvic laparoscopy is also used to obtain a biopsy and treat some pelvic conditions. Because only small incisions are made, it is called a minimally invasive procedure.
The invasive procedures often have a shorter recovery period, less blood loss, and lower levels of post surgical pain than open surgery. Diagnostic laparoscopy can determine whether you have conditions such as endometriosis or fibroids. The procedure also is referred to as band-aid surgery, celioscopy, exploratory laparoscopy, gynecologic laparoscopy or pelviscopy. A variety of surgeries can be done using miniaturized instruments in this procedure, including ovarian cyst removal, tubal ligation, which is surgical contraception and hysterectomy. A gynecologist, general surgeon, or another type of specialist may perform this procedure.

Purpose of Pelvic laparoscopy:

Laparoscopy can be used for diagnosis, treatment, or both. A diagnostic procedure can sometimes turn into treatment. Initially imaging techniques such as ultrasound, CT scan, and MRI are done to observe pelvic abnormalities. A pelvic laparoscopy is done after other noninvasive options have been used. Then the data gathered through these other methods cannot provide a definite diagnosis, this procedure may be able to provide more detail. A pelvic laparoscopy is done to investigate and treat conditions affecting the uterus, ovaries, fallopian tubes, and other organs in your pelvic area
Pelvic laparoscopy is recommended to:

  • determine the cause of pelvic pain
  • examine an abnormality, such as a tissue mass, ovarian cyst, or tumor, which was possibly found in another imaging study
  • confirm the presence of endometriosis, which is a condition in which cells from the lining of your uterus grow outside of your uterine cavity
  • investigate conditions that might cause infertility
  • examine your fallopian tube for obstructions or ectopic pregnancy
  • observe the extent of ovarian cancer, endometrial cancer, or cervical cancer
  • diagnose a pelvic inflammatory disease

A biopsy of the abnormal tissue can be taken during a pelvic laparoscopy. They can also use the procedure to diagnose and treat specific conditions using the video monitor as a guide. This procedure is also used to

  • obtain a tissue sample for biopsy
  • eliminate scar tissue or abnormal tissue from endometriosis
  • perform an appendectomy
  • repair a damaged uterus
  • repair damage to your ovaries or fallopian tubes
  • remove an ectopic pregnancy
  • perform a hysterectomy, or removal of the uterus
  • removal of the ovaries
  • removal of ovarian cysts
  • perform a tubal ligation, which is sterilization of your fallopian tubes
  • remove lymph nodes affected by pelvic cancers

Preparation for a Pelvic laparoscopy:

Any prescription or over the counter medications that you are taking should be informed to your doctor. As they could affect the outcome of laparoscopy, your doctor may change the dose of any medications and will tell you how they should be used before and after the procedure.
These medications include:

  • anticoagulants, such as blood thinners
  • nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin or ibuprofen
  • other medications that affect blood clotting
  • herbal or dietary supplements
  • vitamin K

You should also tell your doctor if you are pregnant or think you might be pregnant. This will reduce the risk of harm to your fetus. Certain blood tests, urinalysis, electrocardiogram (EKG or ECG), and chest X-ray may be done before laparoscopy. Your doctor might also perform certain imaging tests, including an ultrasound, CT scan, or MRI scan. These tests can help your doctor better understand the abnormality being examined during laparoscopy. The images also give your doctor a visual guide to the inside of your abdomen which can improve the effectiveness of laparoscopy. You will probably need to do fasting for at least eight hours before laparoscopy. During this period you can drink only water. Avoid eating and drinking anything else. As Laparoscopy is often performed using general anesthesia, which can make you drowsy and unable to drive for several hours after surgery, you should also arrange for a family member or friend to drive you home after the procedure.

Procedure for Pelvic laparoscopy:

A pelvic laparoscopy  is usually done as an outpatient procedure in a hospital or an outpatient surgical center. You will be able to go home the same day as your surgery. You will likely be given general anesthesia for this type of surgery so that you won't feel any pain during the procedure. An intravenous (IV) line is inserted in one of your veins to receive general anesthesia as well as special medications. Through this IV you will be also provided hydration with fluids. Sometimes local anesthesia is used instead which numbs the area. Even though you will be awake during the surgery, you won't feel any pain. A small cut above your navel about one half inch long will be made by your doctor, once the anesthesia has taken effect. A narrow, tube like instrument called a cannula will be placed into your abdominal cavity to expand the cavity with carbon dioxide. This gas allows your doctor to see your abdominal organs more clearly. Then  the laparoscope will be inserted through the incision once your abdomen is inflated. The images on a screen will be displayed by the camera attached to the laparoscope, allowing your organs to be viewed in real time. The laparoscope will be inserted through the incision near your navel. Up to four dime sized cuts will be made closer to your pubic hairline. These cuts allow space for additional cannulas and other tools that will be needed to perform the procedure.
A uterine manipulator will also be inserted through your cervix into your uterus. This will help move the pelvic organs into view. A small sample of tissue will be taken from an organ to be evaluated during a biopsy. Once surgery has been completed, the instruments and gas from your body will be removed. Your incisions will be closed with stitches or surgical tape. Bandages may be placed over the incisions.

Recovery from a Pelvic laparoscopy:

Before you are released from the hospital, you will be under observation once the surgery is over. Your breathing and heart rate, will be monitored closely. Any adverse reactions to the anesthesia or the procedure will also be checked. Hospital staff will also monitor for prolonged bleeding.
The timing of your release will vary. It depends on:

  • your overall physical condition
  • the type of anesthesia used
  • your body's reaction to the surgery

You may have to remain in the hospital overnight in some cases. As the effects of general anesthesia usually take several hours to wear off, so it can be unsafe to drive after the procedure. Therefore to be on the safer side a family member or friend will need to drive you home if you received general anesthesia.
You may feel moderate pain and throbbing in the areas where incisions were made in the days following laparoscopy. Usually you will have shoulder pain after your procedure as a result of the carbon dioxide gas used to inflate your abdomen to create a working space for the surgical instruments. The gas can irritate your diaphragm, which shares nerves with your shoulder. It may also cause some bloating. The discomfort and pain should go away within a couple of days. Medication are prescribed to relieve the pain. Usually you can resume all normal activities within a week. However, you will need to attend a follow-up appointment with your doctor about two weeks after pelvic laparoscopy.
For a smoother recovery you can follow the below things:

  • Begin light activity as soon as you are able, in order to reduce your risk of blood clots.
  • Get more sleep than you normally do.
  • Use throat lozenges to ease the pain of a sore throat.
  • Wear loose fitting clothes.

Your post surgical instructions will depend on the type of procedure you had. You will be advised not to lift any heavy objects for about three weeks after the procedure. This will reduce your risk of developing a hernia in one of your incisions. However, you can resume your normal diet.

Risks of a pelvic laparoscopy:

Pelvic laparoscopy is considered a surgical procedure. The most common complications are bleeding and bladder infection and skin irritation. However, these risks are minimal. Still, it is important to be aware of signs of infection.
Contact your doctor if you have any of the following:

  • fever
  • vaginal bleeding
  • chills
  • a menstrual flow that is unusually heavy or filled with clots
  • abdominal pain that increases in intensity
  • continued nausea or vomiting
  • shortness of breath
  • redness, swelling, bleeding, or drainage at your incision sites

A pelvic laparoscopy includes a risk of potential internal damage. An immediate open surgery will be performed by your doctor if an organ is punctured during the pelvic laparoscopy.
Rare complications include:

  • a reaction to general anesthesia
  • inflammation or an infection of the abdomen
  • a blood clot that could travel to your pelvis, legs, or lungs
  • a blood clot that could enter your heart or brain
  • the need for a blood transfusion or temporary colostomy
  • damage to an abdominal blood vessel, the bladder, the bowel, the uterus, and other pelvic structures
  • nerve damage
  • allergic reactions
  • adhesions
  • problems with urinating

Conditions that increase your risk of complications include:

  • previous abdominal surgery
  • obesity
  • being very thin
  • extreme endometriosis
  • pelvic infection
  • chronic bowel disease

The gas used to fill the abdominal cavity can also cause complications if it enters a blood vessel. Pay close attention to your body during the recovery period for any of the above complications.

Results of a Pelvic laparoscopy:

A pathologist is a doctor who specializes in tissue analysis will examine the sample if a biopsy was taken. A report detailing the results will be sent to your doctor.
Normal results of a pelvic laparoscopy indicate that the reproductive organs and any other organs examined are normal in size and appearance. A normal report also confirm the absence of cysts, tumors, or other abnormalities in the pelvic area.
Abnormal laparoscopy results can indicate any one of numerous conditions including:

  • adhesions or surgical scars
  • uterine fibroids, which are benign tumors
  • endometriosis, which occurs when tissue from the inside of your uterus grows outside of your uterus
  • cancer
  • cysts or tumors
  • obstruction in your fallopian tube
  • ovarian cysts
  • hernias
  • injury or trauma
  • pelvic inflammatory disease

An appointment will be scheduled with you by your doctor to go over the results. More laboratory tests and more physical exams may be performed before your doctor able to give you a diagnosis. He will discuss appropriate treatment options with you if a serious medical condition was found. You both can work together to come up with a plan for addressing that condition.