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Dr Nikki Kroon MRCOG, Dip Gum, DFFP, Dip Advance Obstetric Ultrasound Consultant Obstetrician & Gynaecologist Having a Laparoscopy Dr Kroon has recommended that you have a laparoscopy. This leaflet provides some general information and advice about the procedure, but your own case may be more complex and the differences will be discussed with you before the operation. If you have an unanswered questions or concerns, please do not hesitate to ask Dr Kroon or a nurse for more information. It is natural to feel anxious, but often knowing what to expect can help. What is a Laparoscopy? A laparoscopy is an examination of the organs within the pelvis or abdomen using a flexible, tube-like telescope called a laparoscope. It is called a ‘key-hole’ procedure because it involves only small incisions (cuts). Laparoscopy is used to help find out what is causing the gynaecological symptoms that you are experiencing. It is normally carried out as a day case, requiring no overnight stay in hospital. Sometimes no cause is found for the symptoms you describe. If this is the case, your Consultant will discuss how to proceed with this information. Sometimes additional procedures are performed at the time of the operation, eg treatment of endometriosis or adhesions, and sometimes we place dye into the womb to check if your tubes are open. This will be discussed with you before the operation. A laparoscopy is performed under a general anaesthetic. This means you will be asleep and will feel no pain throughout the procedure. Preparing for you Operation Before you come into hospital for your laparoscopy, you will need to: o o o o Have a bath or shower on the day of your admission. Remove any rings, make-up or nail varnish and bulky or sharp jewellery. Rings and earrings that you would prefer not to remove can usually be covered with adhesive tape. Follow the fasting instructions given in your admission confirmation letter by your Consultant’s secretary. All women of childbearing age will have Chlamydia screening before the procedure or treatment with antibiotics following the procedure. Mount Carmel Hospital Braemor Park, Churchtown Dublin 14 St Vincent’s Private Hospital Herbert Avenue, Merrion Dublin 4 Suite 16, Blackrock Clinic Rock Road, Blackrock Co. Dublin Dr Nikki Kroon MRCOG, Dip Gum, DFFP, Dip Advance Obstetric Ultrasound Consultant Obstetrician & Gynaecologist When you arrive at the hospital, a nurse will explain how you will be cared for during your stay and will perform some simple tests such as checking your pulse and blood pressure. Dr Kroon and your anaesthetist will also talk to you. This is a good time to ask any outstanding questions about your treatment. Your nurse will help you prepare for theatre. Consent Dr Kroon will sign a consent form with you. By doing this, you confirm that you understand what the procedure involves, including the benefits and risks and give your permission for it to go ahead. Risks Dr Kroon will try to address serious and common less serious complications of a laparoscopy at the time of your clinic visit, and again prior to the operation. Though this leaflet attempts to offer general information, there are times when the risks quoted below may be slightly higher. This may be because you have previously had operations on your tummy, or we may have planned to remove a cyst or ovary, or you are overweight or you are very thin. Serious risks include: o o o o o The overall risk of serious complications from diagnostic laparoscopy, approximately two women in every 1,000 (uncommon) Damage to bowel, bladder, uterus or major blood vessels which would require immediate repair by laparoscopy or laparotomy (uncommon). However, up to 15% of bowel injuries might not be diagnosed at the time of laparoscopy. Failure to gain entry to abdominal cavity and to complete intended procedure. Hernia at site of entry. Death; three to eight women in every 100,000 undergoing laparoscopy die as a result of complications (very rare). Frequent risks include: o o o o Bruising Shoulder-tip pain Wound gaping Wound infection Mount Carmel Hospital Braemor Park, Churchtown Dublin 14 St Vincent’s Private Hospital Herbert Avenue, Merrion Dublin 4 Suite 16, Blackrock Clinic Rock Road, Blackrock Co. Dublin Dr Nikki Kroon MRCOG, Dip Gum, DFFP, Dip Advance Obstetric Ultrasound Consultant Obstetrician & Gynaecologist About the Operation Two small incisions are made in the skin; these cuts are between 0.5 and 1.5 cm in size. The first is made just below the navel, where a hollow needle is used to inflate the abdomen slightly with carbon dioxide gas. This creates more room for your surgeon to work and allows a clearer view of the internal organs. The second incision is made where the laparoscope is to be inserted (this depends on which organs are being investigated). Dr Kroon will then view and probe the area, looking directly through the ‘scope or at pictures it sends to a video monitor. If any treatment is performed, additional small cuts are made in order to insert the necessary instruments. At the end of the operation, the instruments are removed, the carbon dioxide gas is allowed to escape through the laparoscope and the cuts are closed with two or three stitches. After you Operation You will be taken from the operating theatre to a recovery room where you will come round from the anaesthetic under close supervision. After this, you will return to the day care unit, where a nurse will make you comfortable. He or she will assess the operation sites and monitor your blood pressure and pulse at regular intervals. Recovery You will need to rest on your bed until the effects of the anaesthetic have passed. If you are sore, you may require painkillers, which can usually be taken every four to six hours When you feel ready, you can begin to drink and eat, starting with clear fluids such as water and go out to pass water. Going Home If you operation has been planned as a day case, you will be able to go home once you have made a full recovery from the anaesthetic and you feel that the pain is manageable. However, you will need to arrange for someone to drive you home and then stay with you for the first 24 hours. Before you are discharged, the nurse will advise you about caring for your wound. The nurse will also give you a contact telephone number for the hospital, in case you need to ask for any further advice, and will make arrangements for you to have any stitches removed. If you have not had Chlamydia screening you will be prescribed with antibiotics to be taken on the day of your operation. Mount Carmel Hospital Braemor Park, Churchtown Dublin 14 St Vincent’s Private Hospital Herbert Avenue, Merrion Dublin 4 Suite 16, Blackrock Clinic Rock Road, Blackrock Co. Dublin Dr Nikki Kroon MRCOG, Dip Gum, DFFP, Dip Advance Obstetric Ultrasound Consultant Obstetrician & Gynaecologist After you return home If you need them, continue taking painkillers as advised by the hospital. A general anaesthetic can temporarily affect your co-ordination and reasoning skills, so you should avoid driving, drinking alcohol, using power tools, making any vital decisions for 24 hours afterwards. Take things gently for a day or two after returning home. You should follow your surgeon’s advice about heavy lifting or strenuous exercise. You may shower or bath the next day and change the plasters after bathing. The stitches will either dissolve or be removed at a follow-up appointment. Following a gynaecological operation performed laprascopically, it is quite normal to have a small amount of vaginal bleeding. At your follow-up appointment, which will be scheduled after the procedure, your surgeon will advise you when you can resume your other normal activities. Audit Dr Kroon records all the operations that she performs and has logged her cases since 1996. In addition to the operation, she records the complications that her patients have experienced. This is a form of monitoring her performance. If you have any questions regarding this, please ask her when you meet her in the clinic. In addition to this she may wish to record the surgery of your case for teaching purposes if this is acceptable to you. If you are in agreement that the videos may be used for teaching purposes, she will ask you to sign an additional consent form in relation to this. Reference RCOG Guidance on consent for Laparoscopy (Consent no 2, produced December 2008) Mount Carmel Hospital Braemor Park, Churchtown Dublin 14 St Vincent’s Private Hospital Herbert Avenue, Merrion Dublin 4 Suite 16, Blackrock Clinic Rock Road, Blackrock Co. Dublin