Gynaecological laparoscopy

A gynaecological laparoscopy (keyhole surgery) is a procedure to look inside your lower tummy (abdomen) to examine your womb (uterus), fallopian tubes and ovaries. Gynaecological laparoscopy can be used to diagnose a condition and/or to treat it. 

About gynaecological laparoscopy

Gynaecological laparoscopy is used to find out what’s causing certain symptoms you may have, as well as to treat several different conditions. These include:

• diagnosing and treating endometriosis – this is where cells like those that line your womb are found in other parts of your body
• removing scar tissue (adhesions) – scars can develop after infections such as pelvic inflammatory disease or because of endometriosis 
• treating an ectopic pregnancy – this is where a fertilised egg starts to develop outside your womb
• performing a sterilisation, which means closing your fallopian tubes so that you can no longer get pregnant
• removing an ovarian cyst  
• removing your womb ( hysterectomy ) or ovaries (oophorectomy)
• treating fibroids 
• investigating if you have cancer or if a cancer has spread

A specialist doctor called a gynaecologist might take a small sample of tissue (biopsy) during the laparoscopy. This will be sent to a laboratory for testing to see if you have cancer. A biopsy can also help to diagnose endometriosis.

You may also have a gynaecological laparoscopy to find out the cause of any ongoing tummy pain. If you’re trying for a baby but having difficulty, laparoscopy can be used to look for reasons why you might not be getting pregnant. 

Preparation for a gynaecological laparoscopy

Your hospital will explain how to prepare for your gynaecological laparoscopy.

If you’re having a gynaecological laparoscopy to diagnose a condition, you’ll usually have the procedure and go home the same day. If you are having the procedure to treat a condition, you may need to stay in hospital overnight.

A gynaecological laparoscopy is usually done under general anaesthesia, which means you’ll be asleep during the procedure. Your hospital will give you instructions on when to stop eating and drinking. You’ll usually need to stop eating about six hours before your gynaecological laparoscopy and only have clear fluids up to two hours before. But follow your anaesthetist’s advice.

At the hospital, a nurse will test your urine (pee) to check that you’re not pregnant or have any conditions that could affect the procedure. You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs (deep vein thrombosis).You may need an injection of an anticlotting medicine as well as or instead of wearing compression stockings.

Your nurse or doctor will discuss with you what will happen before, during and after your procedure, including any pain you might have. If you’re unsure about anything, just ask. No question is too small. It’s important to feel fully informed so you’re in a position to give your consent for the procedure to go ahead. You’ll be asked to sign a consent form. 

Gynaecological laparoscopy procedure

Gynaecological laparoscopy usually takes about half an hour to an hour if you’re having it to diagnose a condition. It will take longer if your doctor needs to treat a condition. 

Your doctor will make one or more small cuts in your lower tummy, including one in your tummy button (navel). They’ll then put a tube through one of these cuts and pass carbon dioxide through to gently inflate your tummy so they can see better. Next, your doctor will put a small telescope with a camera attached (laparoscope) through another cut. The camera on the laparoscope sends pictures of the inside of your tummy to a monitor where your doctor can see it. Your doctor may pass other instruments through the cuts if they need to take tissue samples or treat a condition.

At the end of the procedure, your doctor will close the cuts with stitches or glue. 

You can have some treatments through the gastroscope. For more information, see our FAQ below: Can my doctor treat my condition during a gastroscopy?

Aftercare for gynaecological laparoscopy

You’ll need to rest until the effects of the anaesthetic have passed. You might have some discomfort as the anaesthetic wears off but you'll be offered pain relief. 

You’ll usually be able to go home after a few hours when you feel ready. Ask family or a friend to take you home, and ask them to stay with you for a day or so while the anaesthetic wears off.Having a general anaesthetic can really take it out of you. You might find that you're not so coordinated or that it's difficult to think clearly. This should pass within 24 hours. In the meantime, don't drive, drink alcohol, operate machinery or sign anything important.

You may have some bleeding from your vagina for the first day or two. You can use sanitary pads until the bleeding stops. If you have bleeding that’s similar to a heavy period, give your hospital a call to seek medical advice.

Your nurse will give you advice about caring for your wounds, hygiene and bathing. You may be given a date for a follow-up appointment.

If you have dissolvable stitches or glue on your wounds, these will dissolve on their own. If you have non-dissolvable stitches, you’ll need to have them taken out, usually after about five to seven days. A practice nurse at your GP surgery should be able to do this for you. 

Recovery after gynaecological laparoscopy

You might have some pain for a few days after your procedure. Your hospital may give you painkillers to take home. Or over-the-counter painkillers such as paracetamol or ibuprofen might help but always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist for advice.

It’s important to rest and take it easy for the first 48 hours after your operation. If you’ve had a straightforward laparoscopy or one to diagnose a condition, you should be back to your usual activities in about three days. And you may be able to go back to work within a week. If you’ve had a more complicated procedure with treatment, it may take two or three weeks to feel like you’re back to normal and can work again. But this will depend on the type of job you do – ask your doctor for advice.

It’s a good idea to keep moving around. You may not feel like it, but it will help prevent other problems later, such as blood clots in your legs or lungs. Your doctor may also suggest you wear compression stockings or have blood thinning injections for a while after your operation. These help to prevent blood clots too.

You shouldn’t drive until you’ve recovered fully. Ask your doctor for advice about when it should be safe for you to drive. 

You should be able to have sex when you feel ready, but follow your doctor’s advice.If you feel unwell, or have any of the following symptoms once you’re at home, contact your GP or hospital for advice:

• a burning or stinging feeling when you pass urine, or passing urine often – this could mean you have a urine infection
• sore, red skin around your scars, which could be a sign of infection
• tummy pain that’s getting worse, which could be a sign of damage to your bladder or bowel
• a red, swollen and painful lower leg, which could be symptoms of a blood clot in your vein (deep vein thrombosis,DVT) 

Side-effects of gynaecological laparoscopy

Side-effects are the unwanted but mostly temporary effects you may get after having a gynaecological laparoscopy. Possible side-effects of a gynaecological laparoscopy include:

• a small amount of bleeding from your vagina
• pain and discomfort in your tummy
• pain in your shoulder – inflating your tummy during the procedure might stimulate a nerve that runs up to your shoulders and neck and cause this
• tiredness
• bruises around your wounds
• feeling sick

Complications of gynaecological laparoscopy

Complications are when problems occur during or after your procedure. The possible complications of having a gynaecological laparoscopy are listed below.

• Other organs in your tummy, such as your bowel, bladder, womb or major blood vessels, may be damaged during the procedure.
• You may develop an infection.
• You may get bleeding, or develop an incisional hernia near a wound. This is a bulge under your skin. It can happen when a wound hasn't healed properly and tissue pokes through. 

If there’s a complication during your laparoscopy, your doctor may need to change to open surgery. This means they will have to make a bigger cut in your tummy.

If you’re having a laparoscopy to find out what is causing your symptoms, there’s a chance that during the procedure your doctor won’t see a clear reason for them. So, you may have the laparoscopy and still not know what’s causing your symptoms. 

Alternatives to gynaecological laparoscopy

Gynaecological laparoscopy isn't suitable for everyone. Your doctor may suggest alternative tests or treatment if you:

• are very overweight
• are older
• have had surgery on your tummy before 
• have a heart or lung condition

Depending on what’s causing your symptoms, there may be other tests or treatments available. For example, if you have endometriosis, your doctor may suggest painkillers and hormone treatments.

Before being offered a gynaecological laparoscopy, you may have an ultrasound scan. This can diagnose some gynaecological conditions, such as endometriosis and fibroids. You can have an ultrasound scan that looks at your womb from the outside, through your lower tummy to check for fibroids. You can also have an ultrasound that looks at your womb from the inside using a device that’s inserted into your vagina. Or you may have another type of scan before a gynaecological laparoscopy, such as a CT scan  or MRI scan. An MRI scan can also diagnose conditions such as fibroids. 

Laparotomy

Laparotomy is an alternative to laparoscopy, and is open surgery. In this procedure, your doctor will make a large cut in your tummy. Or your doctor might suggest a laparotomy for bigger operations such as a hysterectomy. A laparoscopy has some possible benefits compared to a laparotomy – for example, smaller cuts and a faster recovery. But it isn’t suitable for all women. Your doctor or surgeon will talk to you about which is the best option for you.