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Eeyore

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Thursday, May 10th 2007, 10:52am

INFO: A ROUGH GUIDE TO A LAP

If you and your partner are dealing with infertility, then you have probably had a number of diagnostic tests performed in order to find out the exact cause of the problem. Unfortunately, diagnostic laboratory tests are not always conclusive when it comes to determing the root cause of your infertility. As a result, your fertility specialist may suggest that you undergo diagnostic laparoscopy in order to find out more about what is causing your infertily. Diagnostic laparoscopy is a relatively simple procedure that can be used to diagnose and correct a number of fertility issues.


What is Diagnostic Laparoscopy?

Diagnostic laparoscopy is a surgical procedure that allows your fertility specialist to examine the organs inside of your abdomen and pelvis. It is often used when an infertility diagnosis cannot be reached through laboratory tests alone. Performed using small incisions and a miniature camera (known as a laparoscope) laparoscopy allows your fertility physician to take a close look at your:


• uterus
• fallopian tubes
• ovaries
• uterine lining

This enables your physician to make a fertility diagnosis and possibly even correct the problem during the laparoscopy procedure.


What is Diagnostic Laparoscopy Used For?

Diagnostic laparoscopy is used in order to detect complications inside of the reproductive system. In particular, it can be used to diagnose and correct:


• endometriosis
• ovarian cysts
• uterine fibroids
• fallopian tube blockage
• pelvic inflammatory disease

It can also be used to detect and treat an ectopic pregnancy.


How is Diagnostic Laparoscopy Performed?

Diagnostic laparoscopy is typically performed in hospital or in a surgery centre that specializes in laparoscopic procedures. It is performed under general anesthesia, so that no pain is experienced during the surgery itself.

Your physician will make a small incision, a few centimetres in length, just below your navel. A needle will then be inserted into this incision, which is used to pump carbon dioxide into your abdomen. This carbon dioxide works to elevate the wall of your abdomen, so that your physician has enough room to work in. Next, a small tube, known as a trocar, will be passed through the incision in your abdomen. The laparoscope, a kind of tiny camera, is then inserted through the trocar. The laparoscope will transmit images of the inside of your pelvis and abdomen to a television monitor in the operating room. Your physician will use these images in order to diagnose your problem.


Operating with Diagnostic Laparoscopy

If your physician detects a problem during the laparoscopy procedure, he may be able to correct the problem right then and there. If this is the case, a few more incisions will be made on the left and right sides of your abdomen. Your physician will use these incisions to help accomodate scissors and other surgical tools needed to treat the problem. These incisions will then be sewn together once the operation is complete.


Preparing for Diagnostic Laparoscopy


The preparation for diagnostic laparoscopy is relatively straightforward. You will be asked to arrive at the hopsital or surgery centre the night before your operation. You must refrain from eating and drinking for at least eight hours prior to the surgery. Your physician may perform an ultrasound in order to get an idea of what is going on inside of your abdominal cavity. You may also undergo routine blood tests.


Recovering from Diagnostic Laparoscopy

Depending upon your fertility diagnosis, diagnostic laparoscopy can last anywhere from 20 minutes to two hours. After the surgery, you will be kept in hospital for at least two hours, so that your anesthetic can wear off. You will be monitored closely during this time. After two hours you will be allowed to go home, though you must have someone with you who is able to drive you. You may feel a little nausea or some pain in your shoulders or arms (as a reusult of the carbon dioxide), but you won't experience that much pain.

It is recommended that people undergoing diagnostic laparoscopy take the following two days off to rest and recuperate. After five days you may return to work and resume your normal, everyday activities. For the next week or so you may feel some pain or tenderness around the incisions in your abdomen. If the pain isn't too uncomfortable, you can resume sexual intercourse after a week. It is important to keep the incision areas as clean and dry as possible.


Complications Associated with Diagnostic Laparoscopy

As with any surgery, there are complications associated with diagnostic laparoscopy. However, if you are in good health the risks associated with the surgery are extremely rare. The most common complication of diagnostic laparoscopy is infection. If you notice any signs of infection, such as redness or heat, tell your physician as soon as possible. Other possible complications include:


• excessive bleeding
• injuries to the abdomen
• injuries to blood vessels inside the pelvis

Eeyore

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Wednesday, April 22nd 2009, 7:02am

NHS patient care for a laparoscopy



Having a laparoscopy for fertility investigations

What is a laparoscopy?
This is a procedure that allows a doctor to look inside your abdomen to view the ovaries and the outside of your uterus and tubes, using a laparoscope. A laparoscope is a an instrument like a miniature telescope with a light source at the end, which will magnify and light up your abdomen. It is about as big as a fountain pen and twice as long.

Before you go into hospital
• Please refer to your correspondence for specific information as to date, time, location and preparation for your surgery.

• Arrangements should be made for childcare outside the home for the day of the surgery and possibly the next day. A quiet, restful environment is needed when you return home

• Make arrangements for a relative/friend to drive you to and from the hospital and to be there with you for at least 48 hours after the surgery. Expect your first night to be restless.

• Do not eat anything after midnight, the night before the surgery and only drink water up to three hours before your operation if your operation is in the morning. If you have an afternoon operation you should not eat anything from 6am.

Do not smoke after midnight.

• If you are currently taking any medication, ask the doctor if you should stop.

Bowel preparation: you may have been given instruction about this during your pre-operative clinic visit. Bowel preparation is usually recommended if you have endometriosis, pelvic adhesions or pelvic pain. The bowel is prepared using a strong laxative such as magnesium citrate or Picola and is usually followed by an oral antibiotic. While this can be unpleasant, this procedure reduces the risk of surgical complications from bowel injury during your surgery.

• Please shower or bathe the morning of the surgery

• Vaginal preparation is not normally required.

• Please remove nail polish, make up and jewellery the night before surgery

• It is advisable to wear loose fitting clothes to prevent any unnecessary pressure on your abdomen the day of surgery

• Please leave any valuables at home

• It is advisable to have the following items at home for after your surgery – Pain relief (aspirin, Paracetamol, Ibuprofen etc) thermometer, feminine pads, loose comfortable clothing to wear, throat lozenges and a good book/DVD

Before your surgery
After you check in at the hospital, the nurse will ask you to remove all your clothing and put on a patient gown, robe and slippers. The nurse will complete a checklist, including any medications, allergies and other information before your surgery.

Immediately before surgery, you will be asked to empty your bladder. Glasses, contact lenses and jewellery should be removed. Any valuables should be given to the person accompanying you.

What happens during the operation?
The anaesthetist or one of the nurses will walk you into the operating room. The anaesthetist will place adhesive tabs on your chest to monitor your heart rate. While watching the monitor do not be alarmed about any sudden change in your heart rate or pattern, this may be caused by interference and not related to heart activity.

You will be given a general anaesthetic that will make you drowsy and possibly make your vision blurry. Shortly after this you will drift off to sleep.

The surgeon will then make small cuts into your abdomen to allow for instruments to be used. An instrument to move your uterus during the surgery will be placed into your vagina. Carbon dioxide gas is put into your abdomen, making it easier for the surgeon to see the reproductive organs. The gas is removed at the end of the procedure.

A blue dye will be used to make sure that there are no blockages of the fallopian tubes.

How long does the operation take?
This procedure should take no more than 30 minutes.

Are there any risks with this procedure?
All surgery and anaesthesia is associated with some degree of risk, but with a laparoscopy the risk of complications is low.

The main problems arise from injury to the bowl, bladder or blood vessels within the abdomen from the instruments used. It is estimated that this type of complication occurs in approximately 2 cases per 1000 operations performed, most often it is in women who have had previous abdominal surgery or who are having more complex operative laparoscopies performed. It may be necessary to undertake a larger open operation, a laparotomy, to repair any inury.

Are there alternatives to having this procedure?
If you leave things as they are you are unlikely to find what might be causing your fertility problems. Your consultant will have discussed previous x-rays and scans with you, which has now resulted in further investigations.
The advantages of this procedure are that if something is found, it may be possible to treat it during the operation.

After your surgery
After your surgery you will wake up in the recovery room. Once you are transferred from the theatre recovery room (about 10-20 minutes after surgery) you may have visitors. You may not remember conversations immediately after surgery. This is normal and lasts only a short period.

Your consultant will discuss the findings with you and your family after the procedure is complete.

If you are in pain or feel sick, please tell the nurse. You will be given medication for this and it will usually be in the form of injections or suppositories, until you are ready to drink. Pain medication can be given every three to four hours.

You may experience a sore throat, caused by the irritation from the tube in your throat during anaesthesia. It usually lasts only a few days and can be helped by throat lozenges.

How long will I be in hospital for?
You will remain in hospital approximately three to six hours after the procedure. After you are able to empty your bladder, you will be allowed to go home. If additional medications are required, you will be given these to take with you. On occasion, an overnight stay is considered if you are unable to empty the bladder or your nausea is severe.

Care after surgery at home
• Incisions. You will have a half-inch incision below your navel. This incision will not normally have any stitches. You will also have two to four small incisions near the pubic hairline. The incisions accommodate the instruments needed to perform the surgery. They may or may not have a stitch. They will be covered by small dressings, which may be removed 2-3 days following surgery.

• You will have drainage from these incisions for a day or two. It will be watery and pink tinged. If needed, you may reinforce your dressings or change them if they become too wet. In most cases, this drainage lasts less than 48 hours. You may go without a dressing 48 hours after surgery if you wish. You may want to cover your incision with light dressings to protect your clothes or prevent your clothing from rubbing.

• Do not be alarmed if your vaginal discharge is blue, this is just the dye used in your surgery and is quite normal.

Diet
You may be given specific instructions regarding diet before leaving the hospital. In general you must consume only light, easily digested food for a few days. If you experience increasing nausea during this time, please contact your hospital or GP.

Activity
Expect to feel sore and ‘washed out’ for a few days following surgery. Remember to get up and move about, even though you might not want to. Increase your activity gradually during this time.

For a week or two after surgery, expect to tire easily even after slight effort of work or exercise. Do not engage in strenuous activity until 2-3 weeks after the operation.

If you plan to travel, please notify your consultant before your surgery if possible. If an emergency arises and you must travel during the first week of surgery, please notify your consultant or GP before you leave.

The pain relief tablets do what they are supposed to do, which is mask the pain. Therefore, you may feel a false sense of wellness due to taking them, so even though you feel fine during the next day or two, be aware that your body is recovering and take it easy.

Do not lock the bathroom door in case you feel unwell and need to call for assistance. Eat and drink carefully. The last thing that you will want to do following this type of surgery is choke or cough. Sneezing, laughing, crying and shivering from cold may also be uncomfortable. So snuggle up and treat yourself well.

Gas Pains
You may experience some gas pains from residual carbon dioxide that may remain in your abdomen following the procedure. This pain usually presents as shoulder pain or sharp pain underneath the diaphragm. The pains is usually short-lived and will disappear in a day or two. It helps if you get up and move around while you are having the pain and also if you drink hot water or hot tea with fresh lemon. Heat, massage and exercise can also help to relieve this pain.

Infection
Please take note of your temperature every morning for one week. Please notify your GP if you temperature is above 37.5. f you note increasing redness, swelling, pain or unusual drainage from your incisions, please call the hospital. If you experience frequent urination, burning with urination or spasmodic pain in the lower abdomen above the pubic bone, you may have a bladder infection. Please notify your GP if you have any of these symptoms.

Sexual Activity.
Sexual activity may be resumed approximately 2 to 3 days following surgery unless you are told otherwise. However, if you have any pain, vaginal bleeding or discharge, do not resume activity until the symptoms have subsided.

Further information
You will be given a sheet detailing the emergency contact numbers to call in case there are any unexpected difficulties after you are discharged from the hospital.

Consent – What does this mean?
Before any doctor, nurse or therapist examines or treats you they must have your consent or permission. Consent ranges from allowing a doctor to take your blood pressure to signing a form saying you agree to the treatment or operation. It is important before giving permission that you understand what you are agreeing to. If you do not understand, ask.



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