Laparoscopy (Keyhole Surgery) in Gynecology: Uses, Procedure, and Recovery

In short: Laparoscopy is a short operation in which a thin tube with a light is passed through small openings in the abdomen to find or treat the cause of a complaint. It is used for ovarian cysts, fibroids, adhesions, infertility, endometriosis and polycystic ovaries. A diagnostic laparoscopy takes about half an hour and an operative one up to two hours under general anaesthetic; advantages are less pain, a short hospital stay and a return to activity within one to two weeks.

What is Laparoscopy (Key Hole Surgery)?

Laparoscopy is a minimally invasive surgical technique usually performed under general anesthesia, although in some cases local anesthesia can be used.

It is a procedure done for diagnostic purposes, treatment purposes, or both at once — meaning that in many cases, the cause of a problem can be found and treated in the very same operation.

During laparoscopy, your surgeon inserts a small telescope fitted with a light source and a camera, which is connected to a monitor so the internal organs can be seen clearly.

Compared with conventional open surgery, laparoscopy (keyhole surgery) offers several advantages for patients: less pain after the operation, a shorter hospital stay, better cosmetic results with tiny scars, and a quicker return to normal daily activities.

A small cut is made under or through the navel, through which a thin needle is inserted into the abdominal cavity to introduce gas (CO2). The abdomen is gently inflated to a controlled pressure, then a trocar (a slim tube-like instrument) is placed through the small cut, and the telescope is passed through it. The camera is then attached to the telescope so the internal organs can be viewed on the monitor. Smaller trocars are then placed in the lower abdomen, usually on either side (up to three in total), allowing surgical instruments to be introduced so your surgeon can carry out the procedure.

Recovery after Laparoscopy

In the recovery room, the attending nurse will monitor you closely until you are fully conscious, after which you will be returned to your room. If you are discharged the same day, you should arrange for someone else to drive you home.

Because of the effects of anesthesia, you may feel tired or a little dizzy afterward — this is completely normal. Some patients also notice mild shoulder pain during the first 24 hours after surgery, which usually settles on its own.

Minor complications can sometimes occur, such as redness around the incision sites, slight fluid leakage from the small cuts, or a mild fever. These are rare and can be easily managed by your attending doctor.

Serious complications are uncommon: about 2 in every 1,000 women having laparoscopy have an injury to the bowel, bladder or a major blood vessel, which may need open surgery to repair. Please contact the clinic urgently if you develop increasing pain, fever, vomiting or a swollen abdomen after going home.

Indications and Uses of Gynecological Laparoscopy

Gynecologists use laparoscopy to diagnose and treat a wide range of women’s health conditions. General surgeons also use this technique for procedures such as appendectomies and gall bladder removal (cholecystectomy). Common indications for gynecological laparoscopy include:

Ovarian cysts and tumours.

An enlarged ovary may be due to a fluid-filled cyst or a solid mass. Your surgeon can distinguish between the two and, through the laparoscope, remove a cyst or tumour, take a biopsy if cancer is suspected, or remove the entire ovary if necessary.

Removal of fibroids (myomectomy) or destroying them (myolysis)

Fibroids are benign (non-cancerous) growths that develop from the muscular wall of the uterus. They are common, affecting around 20% or more of women over 35. Fibroids can cause painful or heavier periods, and during pregnancy they may sometimes lead to complications such as premature labour.

When large fibroids are removed laparoscopically, they need to be cut into pieces to take them out. International safety warnings (FDA 2014 and 2020) advise that this is done inside a protective bag and after careful assessment, because rarely an unsuspected cancer can be present; your surgeon will discuss this with you.

• Fibroids

Infertility and lysis of adhesions.

Adhesions (internal scar tissue) are a common cause of infertility, often resulting from previous surgery or pelvic infection. With operative laparoscopy, adhesions can be carefully cut, and they are generally less likely to recur compared with the same procedure done through conventional open surgery.

Infertility: checking the condition and patency of the Fallopian tubes

During laparoscopy, your surgeon can carefully check the condition of your Fallopian tubes and whether they are open. A special dye is injected through the neck of the uterus, and if the tubes are patent (open), free spill of the dye is observed.

Reproductive or tubal surgery

Repairing damaged Fallopian tubes in selected cases (such as reversal of sterilization or mild tubal damage). If a tube is badly blocked and swollen with fluid (hydrosalpinx), removing or blocking it before IVF improves the chance of pregnancy.

Endometriosis.

In this condition, tissue similar to the lining of the uterus (endometrium) implants outside of the uterus, in areas such as the ovaries, pelvis, or intestines. When it affects the ovary, it can form a fluid-filled cyst containing old blood, known as a chocolate cyst.

Endometriosis can lead to adhesions and cause pain during and before periods, painful intercourse (dyspareunia), painful bowel movements, or painful urination.

It can also contribute to infertility. Today endometriosis is often diagnosed from symptoms, examination and specialised ultrasound or MRI, and treatment can start without surgery. Laparoscopy is used when imaging is normal but symptoms persist, or when surgery is needed; endometriosis and adhesions found can then be treated during the same procedure.

Intraperitoneal Hemorrhage.

When there is internal bleeding within the abdomen and the cause is unclear, laparoscopy can help locate the source so it can be treated right away. In some cases, this bleeding may be due to a pregnancy located in the Fallopian tube (ectopic pregnancy), which can also be managed using laparoscopic equipment.

Polycystic Ovaries.

This condition affects around one in eight to one in ten women of reproductive age and occurs when the ovary’s normal function is disrupted, leading to many small follicles forming instead of maturing normally.

It is usually diagnosed with ultrasound and managed with medication. Surgery is only considered in cases resistant to other treatments, where multiple ovarian drilling may be performed using the laparoscope.

Pelvic infection (Pelvic Inflammatory Disease):

Laparoscopy can help diagnose this condition, especially in chronic cases where the cause of pelvic pain is otherwise unclear. A sample may be taken and sent for bacteriological culture, allowing the appropriate antibiotics to be prescribed.

Egg collection for assisted reproduction:

Almost all egg collections for IVF are done through the vagina under ultrasound guidance. Only rarely, when the ovaries cannot be reached this way (for example, if they sit high in the abdomen), laparoscopy may be used instead.

Sterilization (laparoscopic sterilization)

For couples who have completed their family and do not wish to have more children, laparoscopic sterilization is an option. Today, removing the Fallopian tubes completely (salpingectomy) is often preferred over clips, rings or cautery, because it is very effective and also lowers the risk of some ovarian cancers.

• Severe period pain
• Diagnosis and treatment of some uterine anomalies.
• Pelvic floor and vaginal prolapse
• Urinary incontinence
• Some reproductive cancers
• Evaluation and removal of pelvic lymph nodes.

Hysterectomy:

When removal of the uterus is needed, this can be performed entirely through laparoscopy or with laparoscopic assistance through the vagina (laparoscopic assisted vaginal hysterectomy).

If you have questions about whether laparoscopic surgery may be right for you,

If you are preparing for such a cycle, our step-by-step IVF guide explains what it involves.

Dr. Najeeb Layyous and his clinical team are available to discuss your individual situation and guide you through your options.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist