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Laparoscopy
Objective and definition
This intervention consists of examining under general anesthesia the inside of the abdominal cavity and in particular the genitals (uterus, ovaries, tubes) using a camera of a few millimeters, introduced through an incision at the level of the umbilicus.
Other infracentimetric incisions are made in the supra-pubic region to introduce fine instruments to perform the surgery.
The first goal of laparoscopy is to establish a diagnosis which makes it possible to look for an abnormality undetectable by other means (endometriosis or adhesions) or to confirm the suspected diagnosis by other examinations (ultrasound or clinical examination). Multiple interventions can be performed by laparoscopy:
Unilateral or bilateral oophorectomy which involves the removal of one or both ovaries. Removing an ovary if the other ovary left in place is normal does not affect the regularity of cycles.
Ovarian cystectomy which consists of the removal of a cyst present in the ovary while preserving it.
Salpingectomy which consists of the removal of the uterine tube, especially in the event of a blocked tube following an infection (hydrosalpinx) or sometimes during an ectopic pregnancy.
Uni or bilateral adnexectomy. The appendix consists of the proboscis and the ovary located on the same side.
Salpingitis or infection of the internal genital organs (uterus, ovaries, and tubes): in the face of a suspicion of peritonitis, laparoscopy makes it possible to specify the origin of the infection (appendix, genitals, other …). If an abscess is visualized, surgical drainage of it will speed healing. Antibiotic treatment will be initiated.
Ectopic pregnancy or pregnancy located outside the cavity of the uterus (most often in the tube): if GEU is suspected, laparoscopy can confirm this diagnosis. Depending on the location of the GEU, tube preservation may be attempted (salpingotomy) or salpingectomy should be performed. Other locations of GEU are rare but can occur and require specific treatment. Your blood type must be communicated to the doctor.
- Myomectomy (resection of one or more uterine fibroids)
- Tubal reanastomosis: re-opening of the tube after tubal ligation (see sheet)
- Tubal plasty or salpingoneostomy: reopening of a blocked fallopian tube (see sheet)
- Hysterectomy: removal of the uterus via abdominal hysterectomy instrument set
- Prolapse cure (cfr sheet)
Lymphadenectomy: the excision of lymph nodes located in the pelvis and along the aorta as part of an extension workup or treatment of gynecological cancers.
Side effects of the intervention
If you have not gone through menopause and the ovaries or at least one ovary is left in place, its function will persist until natural menopause. There will therefore be no symptoms of menopause directly after the procedure.
If you are not menopausal and both ovaries are removed during the operation, it will therefore lead to menopause and you may have symptoms, such as hot flashes… Replacement medical treatment could be discussed with your gynecologist.
If you have already gone through menopause, removing your ovaries will not have any particular side effects afterwards.
In the event of bilateral salpingectomy, no spontaneous pregnancy may be possible. If you want to become pregnant, medically assisted procreation such as in vitro fertilization should be discussed with your gynecologist.
In the event of a unilateral salpingectomy, if the tube and ovary on the other side are normal, spontaneous pregnancy may well be considered.
If you have been operated on for a GEU with conservative treatment (salpingotomy), you will be offered monitoring of the decrease in the pregnancy hormone. This is to check by a weekly blood test that the pregnancy blood test becomes negative again. In the event of unfavorable evolution of the blood test, medical treatment may be instituted. In rare cases, a second surgery is sometimes necessary.
In case of myomectomy, pregnancy should be avoided for 3 months in order to allow proper healing of the uterus. If the myomectomy scar is deep or multiple, a cesarean section will be indicated for subsequent pregnancies.
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