How is the recovery?  
The large incision used in many traditional operations causes more damage to layers of skin, muscle, and other body tissues. It takes a long time for the body to repair that damage - usually about six weeks. During that period, patients often have to restrict their normal activities so that the incision heals properly.

But in case of laparoscopy where incisions are small, there is less tissue trauma, no exposure of the abdominal contents to the atmosphere, and very minimal handling of the abdominal organs. . Individuals remain in the hospital for a shorter period, experience less discomfort, heals quickly, and can return to daily activities faster than with traditional "open surgery."

Top^

How do I prepare myself before laparoscopic surgery?  
Though the incisions are so small, minimally invasive surgery cannot be done with a local anesthesia. General anesthesia still is necessary for most operations, including those on the abdomen and pelvic areas. That's because general anesthesia does more than block the sensation of pain; it also relaxes muscles and makes it easier for the surgeon to work inside the body and complete the operation.

Because of the effects of general anesthesia, you may feel groggy for a few hours after you awake and you may not be in complete control of the reflexes needed to drive a vehicle. It is safer to have someone else who is fully alert to do the driving on that particular day of surgery.

Top^

Why does the doctor want to videotape my surgery?  
Is that standard for laparoscopic operations? A videotape gives the most detailed possible record of the operation. Surgeons normally dictate an account of the operation and a paper record goes into the patient's file, but the amount of detail varies from surgeon to surgeon.

Almost every operating room with modern laparoscopic equipment can videotape each procedure, creating a visual document of the operation. A record of the operation clearly shows what the surgeon found during the first operation, what difficulties were encountered, and what procedures were done. The record is very important for other doctors who may be involved in your care at some point of time.

Top^

Before the Day of the Surgery  
You need to have a few routine lab tests done. These tests tell us if you are well enough to undergo the surgery.Follow instructions provided whereby
1. You are kept on a liquid diet for a day prior to surgery.
2. Do not eat or drink anything after midnight and the morning before the procedure.
3. Do not even drink coffee, tea or water.

Top^

On the day of the surgery? 
1. You are usually in the hospital for a day
2. By the evening of the operation you can walk to the bathroom and by the next morning you can have a shower.
3. The anesthesiologist may ask questions about the patient’s health, discuss the procedure and explain what to expect from the anesthesia.
4. Before the surgery, an intravenous line, which consists of a small flexible plastic tube, may be inserted into a vein in the patient’s arm or hand. It is used to give medications and fluids during the operation. Sometimes intravenous medication is administered before surgery to help the patient relax.
5. The small incisions are stitched with self absorbing sutures which do not have to be removed. So you will only have a dressing on the incisions.
6. If you have had hysteroscopic myomectomy you will not have any scars on the abdomen, but may have bleeding which may last few days.

Top^

What to Expect after the Surgery? 
The effects of general anesthesia make most people feel groggy at first, but they quickly become more alert. Some people experience nausea for a short time after awakening from a general anesthesia. In the recovery room, the individual first rests in bed, then gradually sits up, stands and walks as balance and mobility are regained. Some laparoscopic procedure requires an overnight hospital stay.

Top^

What problems can occur after Surgery?  
Complications after laparoscopic surgery are rare. Most people recover quickly and resume their normal activities without problem. However, the risk of infections or other problems exists as with any kind of surgery.

Some of the problems can be-
1. There may be some soreness near the incisions, especially when twisting or stretching the body.
2. There may be discomfort in the abdomen, upper chest, shoulders, and neck area but this disappears quickly. You may notice a change in bowel habits for a few days.
3. You may stay in the hospital 1 to 3 days to recover from the surgery. You are started on liquid diet the next day after surgery and gradually shifted to soft and later full diet.
4. You can resume your normal routine activity within a couple of days.
5. You should avoid heavy strenuous activity.
6. You are expected to come back for a follow up after one week.

Top^

What Self –Care is necessary after returning home? 
Individuals who have laparoscopic surgery should carefully follow their doctor’s instructions after going home. The exact kind of care needed depends on the type of surgery, the individual’s age and general health, and other factors. In general, people recovering from Laparoscopic surgery should care for their incision as directed by the doctor, be cautious about certain activities, and watch for any of the warning signs. You should report to the doctor in case of any change in health.

Following laparoscopy on the abdomen or pelvic areas, it is most likely that one will :
1. Leave the adhesive bandage or dressing on the incision till your next visit. The bandage is waterproof so you can have a shower with it on.
2. In case the bandage comes out, please wash the area with soap water, dry it and apply a water proof Band-Aid.

Top^

How long will it take for full recovery?  
Recovery time depends on the kind of procedure, the patient’s age, and health before the procedure.

The following is a normal timetable for recovery from minimum invasive surgery on the abdomen:
1. The groggy feeling from the anesthesia disappears the day after surgery and the individuals is fully alert once again.
2. Any pain in the shoulders or neck is usually goes away after a few days.
3. Soreness in the incisions disappears within a few days and the incision heals in about five days time.
4.The bloated feeling after abdominal or pelvic laparoscopy goes away within a few days.

Top^

When can I go back to work?  
Depending on the procedure most people feel well enough to return to work or normal daily activities three to five days after laparoscopy, although some people may need a week or more of rest.

Looking towards the future
New developments in minimally invasive surgery should result in operations that are even easier on the patient and the treatment of a wider range of diseases.

In the future, minimally invasive surgery will:
1. Use even smaller incisions that heal faster with almost invisible scars. The standard laparoscope is about one-half inch in diameter. Newer micro-laparoscopes are about one-tenth of an inch in diameter so that some procedures can be performed through small hollow needles.

2. Be done for more and more disease. Researchers are developing minimally invasive methods for many types of surgery that currently require larger “Open” incisions.

Use computerized technology developed to run industrial robots. A doctor located hundred or thousands of miles from the operating room may perform laparoscopic surgery. The doctor may use an image transmitted over the internet, and move surgical instruments by remote control.

Top^

How common are hysterectomies? 
Hysterectomy is the second most common major surgery among women. (The most common major surgery that women have is cesarean section delivery). The latest technique is Total Laparoscopic Hysterectomy Surgery where the entire surgery is done laparoscopicaly with out any vaginal procedure which gives the patient lots of benefit as her entire pelvic floor is not disturbed.

Top^

Why do women have hysterectomies? 
Hysterectomies are most often done for the following reasons:

1. Uterine Fibroids – Fibroids are common, benign (noncancerous) tumors that grow in the muscle of the uterus. More hysterectomies are done because of fibroids than any other problem of the uterus. Fibroids often cause no symptoms and need no treatment, and they usually shrink after menopause. But sometimes fibroids cause heavy bleeding or pain.

There are alternatives to hysterectomy to treat fibroids, which may be especially important for younger women who hope to have children. Sometimes fibroids are treated with medicine or other treatments designed to shrink the fibroids. But, this is only temporary – when the medicine is stopped, the fibroids will grow again. A type of surgery to remove only the fibroids without removing the uterus is called a myomectomy.

2. Endometriosis – This is another benign condition that affects the uterus. Endometriosis is the second leading reason for hysterectomies. It is most common in women in their thirties and forties, especially in women who have never been pregnant. It occurs when endometrial tissue (the inside lining of the uterus) begins to grow on the outside of the uterus and on nearby organs.

This condition may cause painful menstrual periods, abnormal vaginal bleeding, and sometimes loss of fertility (ability to get pregnant). Endometriosis is usually not a problem for women after menopause. Women with endometriosis are often treated with hormones and medicines that lower their levels of estrogen. Surgery to remove the patches of endometrial tissue causing the symptoms may be done using a laparoscope or through a larger cut in the abdomen (laparatomy). A hysterectomy is generally the last resort unless other treatments have failed.

3. Uterine Prolapse – This is a benign condition in which the uterus moves from its usual place down into the vagina. Uterine prolapse is due to weak and stretched pelvic ligaments and tissues. Other organs such as the bladder can also be affected. Childbirth, obesity, and loss of estrogen after menopause may contribute to this problem. Uterine prolapse accounts for about 16 percent of hysterectomies.

Treatment may include estrogen therapy, exercises to strengthen pelvic floor muscles, or use of pessary, a plastic ring inserted in to the vagina to help support the uterus. In more sever causes, surgery can restore the sagging organs to their normal location and repair the supporting tissues. Sometimes a hysterectomy may be done if the prolapse is causing severe problems. Cancers affecting the pelvic organs account for only about ten percent of all hysterectomies.

Endometrial cancer (cancer of the lining of the uterus), uterine sarcoma, cervical cancer (cancer of the cervix), and cancer of the ovaries or fallopian tubes often require hysterectomy. Depending on the type and extent of the cancer, other kinds of treatment such as radiation or chemotherapy may be used as well.

Other reasons why hysterectomies are done include chronic pelvic pain, heavy bleeding during or between periods, and chronic pelvic inflammatory disease.

Top^

What should I do if I am told that I need a hysterectomy? 
If you have a condition that is not cancer, such as fibroids, endometriosis, uterine prolapse, or abnormal bleeding there are often other treatments that should be tried first. In most cases, a hysterectomy need not be done immediately. There is time for you to get more information and look into possible alternatives.

In cases of serious disease, such as cancer; a hysterectomy may not be optional and may be a life-saving choice. Before you decide what to do, it is important that you understand your condition and your options for dealing with it. If you are suffering from severe pelvic pain and abnormal uterine bleeding and other treatments have not helped, a hysterectomy may provide welcome relief.

Studies have shown that a hysterectomy often improves sexual functioning and quality of life for women suffering from these problems.

Top^

How is ectopic pregnancy treated? 
If an ectopic pregnancy is confirmed, it can be treated in following ways.

1. Medicines- In some hospitals the drug methotrexate, which terminates the pregnancy, can be used instead of surgery. This treatment is most effective in very early pregnancy and it can be used where there is no bleeding and the tube has not ruptured.

The pregnancy is lost and reabsorbed by the mother, who will then experience bleeding for a couple of weeks. Methotrexate may also be used if the ectopic is picked up very early on and the levels of the pregnancy hormone Beta HCG are still fairly low.

2. Laparoscopic surgery- By laparoscopic surgery ,if the ectopic pregnancy is unruptured the tube is cut and pregnancy is removed, leaving the tube intact.

If the tube has ruptured, laparoscopic surgery removes the pregnancy and the damaged tube. In some cases, a blood transfusion may be needed to replace lost blood.

However, do let your doctor know if you are breastfeeding an older child or if you have certain health conditions. In such cases, your doctor may not prescribe the medicine and would look at other options, which may include surgery.

Note: If your blood is Rh-negative, you'll need a shot of Rh immunoglobulin after being treated for an ectopic pregnancy (unless the baby's father is also Rh negative).

Top^

Will it affect my fertility? 
Possibilities are there. If your fallopian tubes are undamaged after an ectopic pregnancy, then your chances of conceiving again remain the same. If one of the tubes was ruptured or badly damaged, your chances of conceiving again are reduced.

Some 65 per cent of women will conceive again within 18 months of an ectopic, but if both your fallopian tubes were damaged or ruptured, you may need to think about IVF (invitro fertilization) treatment.

Top^

What are the chances of having another ectopic? 
There's about a 10% risk of having another one. However, the risk is difficult to generalize because of the differences in individual circumstances and the extent of the damage that takes place. That means that your overall chances of having a normal pregnancy next time around are still high. You should arrange for a follow up appointment and ask for clear advice about your own future pregnancies from a consultant obstetrician.

When you do become pregnant again, see your doctor as soon as you can as you would be referred to an early pregnancy unit for a scan to check that your pregnancy is developing in the right place and not in the tubes.

There is little you can do to prevent an ectopic pregnancy from happening in the future, although if your ectopic has been caused by a current Chlamydial infection you can have a course of antibiotics to clear it up and reduce further damage to your tubes.

Top^

How long should I wait before trying for another? 
Normally women who've had a laparoscopy are advised to wait three to four months before trying to conceive again. If you have had abdominal surgery, it's best to wait for six months to allow scarring to heal.

Top^