
Gynecological laparoscopy in Iran
Gynecological laparoscopy is a modern surgical approach to examine the pelvic cavity and outside of the organs like fallopian tubes, ovaries, and uterus using the laparoscope guide (camera) thruogh small incisions on the abdomen.
GOALS
• Examination of female reproductive system including uterus, ovaries, fallopian tubes
• Detection and diagnosis of infertility reasons, fibroma, endometriosis, ectopic pregnancy and cysts
GYNECOLOGICAL LAPAROSCOPY IN IRAN: ALL YOU NEED TO KNOW
Exploratory gynecological laparoscopy is a procedure for examining the pelvic structure and cavity using a laparoscope (a very small camera). The examination provides important information regarding the cause of infertility and gynecological disorders, which can’t be detected by physical exam. Besides the outside of uterus, ovaries and fallopian tubes, the doctor can see other abdominal organs such as the bladder. If during the procedure, an abnormal condition is detected, the operative laparoscopy can be performed at the same time.

What are the causes of gynecological laparoscopy?
The doctors often recommend this approach when other methods such as ultrasound and X-ray, can’t reveal the cause of the problem. Some conditions that may need to do laparoscopy are as follows:
• To determine the cause of pain in pelvic and abdominal areas
• To assure the diagnosis of endometriosis (taking biopsy), uterine fibroids, ovarian cysts, scar tissues (adhesions) and ectopic pregnancy
• To find the possible causes of infertility such as blocked fallopian tubes right after the end of your menstruation.
• To assess the uterine cavity with the history of infections in the pelvic area
• To take biopsies to detect abnormal masses and determining the possibility of reproductive cancers
How can we prepare for gynecological laparoscopy?
• It is better to tell your physician if you think you’re pregnant. You will have a urine test to make sure you’re not pregnant anyway.
• It is strongly suggested to inform your doctor about the medications you’re taking.
• Smoking is prohibited a week before the procedure.
• Since anesthetics can make you nauseous, your doctor will recommend you to not eat anything 8 hours before your procedure. You should not drink 2 hours before the procedure as well.
• Your doctor may ask you to stop taking blood thinners such as aspirin
• You may need other diagnostic tests
• Ask any question you want and be informed about the procedure.
• Wear comfortable clothes and shoes at the surgery day
• Arrange for somebody to take you home since you won’t be able to drive for 24 hours after the surgery.

What are the risks of gynecological laparoscopy?
Gynecological laparoscopy may bring some complications just like any operation. Considering all the complications, 1 or 2 women of every 100 may be involved with these risks. The complications may include:
• Small vaginal bleeding
• Skin irritation
• Pain in abdomen and shoulders
• Infection in the pelvic area after the operation
• Small possibility of adhesion (scar tissue formation)
• Bruising at the incision site and hematoma
Complications that are more serious but rare are:
• Damage to nearby organs and tissues including the bowel, blood vessels, the uterus, nerves, the bladder, and other pelvic organs.
• Issues in urinating and urinary retention
• Blood clot formation in veins (venous thrombosis)
These conditions may increase the probability of developing complications:
• History of abdominal surgery or adhesions
• Obesity or extremely low weight
• Severe endometriosis
• Present pelvic infection
The discomfort will subside after 2 days. Overall, the risks of laparoscopy are much lower compared to open procedures.
What can we expect from a gynecological laparoscopy?
The operation is accomplished under general anesthesia. You will be lying down with your head lower than your legs in a slightly tilted position.
Then a laparoscope is inserted inside the abdomen through an incision near the navel. The abdomen is inflated with CO2 gas to give a better view of the organs and keep away the abdomen wall to reduce the risk of injury. For taking biopsies, the laparoscope may be equipped with surgical devices.
In diagnostic laparoscopy, there is often no need for another incision. However, the surgeon may make another incision at the hairline of the pubic area to move pelvic organs into a more clear view and occasionally injecting fluid to determine blockages in the tubes. The second incision is used to insert additional instruments. After the operation, you will stay for an hour in the recovery room. In most cases, you will be discharged after four hours. However, in rare cases, you may need to stay overnight.

Gynecological Laparoscopy FAQs
1. How long does the laparoscopy take?
Diagnostic gynecological laparoscopy usually takes as little as 15 to 30 minutes to complete. Usually, you will be discharged on the same day. If you should undergo laparoscopy it will take up to 2 hours in complicated cases nonetheless you may need to stay in the hospital for around 4 days.
2. When can I return to my daily activities?
Your recovery time and your limitations depend on your procedure treatment. In diagnostic cases, you can start driving a day after the operation. You may be advised to avoid intercourse and inserting tampons until you are healed completely which is one week. Your doctor will give you instructions on how to bath and whether or not you should avoid douching and heavy activities. Generally in operative laparoscopy, the full recovery takes 4 to 6 weeks.
3. Is it normal to feel pain urinating after the procedure?
This issue happens following operative laparoscopy. You may feel sore if the urine reaches your vaginal stitches or a pulling feeling at the time of urination.
4. Is laparoscopy considered as a safe procedure?
It is considered a safe operation. Only about 3 in 1000 women develop complications in this procedure.
5. Is laparoscopy painful?
During the procedure, you won’t feel any pain. After the procedure, you may experience back, shoulder and abdominal pain. In the abdomen area, the disruption of tissues and incisions at port sites are the main source of the pain. Shoulder pain happens because of the stretching and irritation of diaphragm following inflation by carbon dioxide. Draining the residual gas during a few hours after the laparoscopy significantly reduces the pain in the shoulders.
6. Should I get examined, if the laparoscopy shows one of the immediate family female members have endometriosis?
Women with a close relative, who has endometriosis, have a higher risk of developing endometriosis themselves. Therefore, it is a good idea to get checked if you experience painful menstruation and pelvic pain than makes difficulty with your daily life.
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