What to Expect
The laparoscopic procedure can last anywhere from 45 minutes to 5 hours or more, depending upon the individual and the specifics of the case. It is performed under general anesthesia, typically on an out-patient basis in a hospital operating room setting. Less commonly, some patients may find themselves with an unanticipated overnight stay depending on the nature and outcome of her situation.
Before the Surgery
While still a surgical procedure, laparoscopy is a minimally invasive technique with relatively low complication rates and a rapid recovery time. In the pre-op phase, a patient will likely be sent for lab tests, generally including blood and urine cultures. The day before surgery, the patient may be placed on a restricted diet and asked not to eat in the last 8 to 12 hours before her procedure. A bowel prep is often given the night prior, in order to thoroughly evacuate the gastrointestinal tract of waste and bacteria as a precautionary measure.
Patients are typically asked to arrive at the hospital prior to their scheduled surgery time in order to be prepped. All jewelry, nail polish and hair accessories must be removed. Generally, the patient is taken to the operating room or an ambulatory surgery room close to the OR for prep. There she will have an IV hooked up through which various medications and solutions can be introduced. A sedative-like substance will likely be administered, and she may drift off to sleep before anything else is done.
In The Operating Room
Once in the operating room, a small amount of hair will be shaved from the "bikini area" and the entire surgical field (most commonly, this refers to the abdominal and pelvic regions) will be washed with antiseptic. Electrodes to monitor heart function are placed on the chest and arm and are hooked up to an electrocardiogram monitor. An anesthesiologist will intubate the patient (who is not awake at this point) with an endotracheal tube, which goes through the mouth into the windpipe. Oxygen and anesthetics are pumped into the lungs via this tube.
A manual pelvic exam is often performed before the start of the surgery to palpate any nodules that may be present in the lower genital tract. If a hysterosalpingogram ("dye test") is also scheduled, a cannula will be inserted into the cervical opening to manipulate the uterus and inject dye through the Fallopian tubes. Once all pre-operative preps and tests are done, a catheter will be inserted into the urethra to drain urine throughout the procedure. The operating table will be tilted into a position called “Trendelenberg”, so that the head is lower than the feet. This enables the organs to "fall back" and afford the surgeon a better view.
Recovery time varies. After the procedure, the patient will be sent to the recovery room and allowed to awaken gradually. Once stabilized, she will be allowed to leave the hospital and begin her recovery at home. She will be given a prescription for post-operative medication to help assuage some of the pain. Significant discomfort for one or two days post-op can be expected, most often from the gas that is injected during the surgery. The gas pain can linger and reach as high as the shoulders. Remaining ambulatory can help expel the gas and alleviate some of the associated pain. Depending upon the patient and what procedures have been performed, she may be back on her feet and pursuing limited activity within a few days. Other patients have reported that it has taken as long as 10 days for them to recuperate. Bruising at the site of the punctures and a slight amount of bloody discharge is typical. Of course, any symptoms that cause alarm, including extreme pain, should be reported to the surgeon’s office immediately.
Postoperatively, patients may wish to have light foods such as broth on hand until normal appetite gradually resumes. Clothing such as loose dresses or high-waisted, elastic pants are also recommended for the days following the laparoscopy to keep pressure off the puncture sites. Showering is generally allowed the day after. Do not resume any strenuous activity until the surgeon advises it is safe to do so. Findings and any post-operative treatment options will be discussed in the follow-up visit with the surgeon.