小白老师说：作者 Lori Smith用深入浅出的语言介绍了腹腔镜的概念、临床上使用腹腔镜的原因、优势和风险。

A pelvic laparoscopy is a surgical procedure in which an instrument called a laparoscope is used through a small incision in the abdomen.

With these small incisions being only approximately ½ inch long, the procedure is commonly referred to as a “minimally invasive surgery” and avoids the need for an open surgical procedure.

The procedure is commonly performed under general anesthesia, and so patients will usually be completely asleep when undergoing a laparoscopy. However, regional anesthesia can be used when appropriate.

Although a laparoscopy, also known as keyhole surgery, can be used in a number of different forms of treatment such as hernia repairs, this article will focus on the gynecological applications of the pelvic laparoscopy.

What is a laparoscopy?

During a laparoscopic procedure, the laparoscope - a thin device with an attached light and camera - is inserted into the navel or abdomen through a small incision in the abdomen. The abdomen is then filled with carbon dioxide using a catheter, allowing for better visualization of the abdominopelvic organs.

At times, additional surgical instruments will be used. Instruments can be inserted through the same incision, although other insertion sites may be made. Up to four small incisions can often be expected.

An instrument called a uterine manipulator may be used; this device is inserted into the vagina, cervix and uterus to allow for pelvic organ movement.

Once the procedure is complete, the surgeon will remove most of the carbon dioxide from the abdomen, remove all used instruments, close the incisions with stitches and cover the area with small bandages.

Following the procedure, the patient may feel tired and nauseated from the anesthesia. Most patients are discharged from hospital on the day of their surgery, although hospitalization may be necessary in some instances - to enable recovery after a laparoscopic hysterectomy, for example.1

A pelvic laparoscopy can be used to diagnose and/or treat conditions such as ovarian cysts.

Reasons for a laparoscopy

A laparoscopy can be performed for a variety of reasons, health conditions and diagnoses including tubal ligation, diagnostic procedures and treatment of certain conditions.

Common reasons for undergoing a laparoscopy include:

1. Diagnosis and treatment of endometriosis, chronic pelvic pain, pelvic inflammatory disease and/or infertility

2. Removal of fibroids, appendix, uterus, ovarian cysts, lymph nodes or an ectopic pregnancy

3. Treatment of disorders such as urinary incontinence, pelvic organ prolapse or certain forms of cancer

4. Evaluation of the extent of certain cancers including of the ovary, uterus and cervix.

Benefits and risks of having a laparoscopy

As with any surgical procedure, there are risks and benefits to a laparoscopy. The benefits of the procedure are most apparent when comparing a laparoscopy to open surgery.

A laparoscopic procedure will typically have a shorter recovery period and involve less pain than open surgery.

The benefits of having a laparoscopy include:

1. Less pain in comparison with an open procedure

2. Faster recovery

3. Smaller incisions

4. Less risk of infection.

Risks associated with a laparoscopy include:

1. Bleeding

2. Infection

3. Hernia

4. Risk of internal damage to structures such as such as blood vessels, the stomach, bowel, bladder or ureters

5. Adverse reactions to anesthesia

6. Abdominal inflammation or infection

7. Blood clots

8. Potential for a blood transfusion or colostomy.

Recovery after laparoscopy

You may experience an array of symptoms for a few days following a laparoscopy, including:

1. Fatigue

2. Sore throat (from use of breathing tube during surgery)

3. Discomfort at the sites of incision

4. Abdominal bloating

5. Shoulder or back pain from any remaining carbon dioxide within the abdomen which irritates the diaphragm - this will resolve in a few days.

Symptoms to report to your health care team include:

1. Worsening or severe pain

2. Nausea or vomiting

3. Heavy vaginal bleeding, heavy menstrual bleeding or menstrual clotting

4. Fainting

5. Signs of infection, including fever, chills or redness, swelling and discharge at the site of incision

6. Inability to empty bladder

7. Shortness of breath.

These symptoms could indicate a complication arising from the procedure that may require further treatment.

Patients can typically resume normal activities within 1-2 days after surgery. However, you should discuss specific limitations and instructions with your health care provider, which may include avoiding heavy lifting for 3 weeks.1,2

Written by Lori Smith BSN MSN CRNP