Gynae Laparoscopy in Singapore

What is gynecologic laparoscopy? 

Gynae or gynecological laparoscopy is keyhole surgery that allows your doctor to examine your pelvis surgically. It is typically performed for diseases involving the uterus, fallopian tubes and/or ovaries. 

Gynae laparoscopy differs from traditional open surgery as it is minimally invasive, involves small surgical incisions, is associated with less pain and patients undergoing laparoscopic procedures typically make a faster recovery with shorter downtime. At ACRM, our female ObGyns are both accredited with the highest level (Level 3) of gynae laparoscopic accreditation.

What is the purpose of gynae laparoscopy?

Gynae laparoscopy can be divided into diagnostic and therapeutic. In many cases, gynae laparoscopy can serve both purposes in the same setting.

Diagnostic laparoscopy allows your gynaecologist to examine your pelvis surgically and diagnose diseases that involve your uterus, fallopian tubes and/or ovaries. 

Therapeutic laparoscopy allows your gynaecologist to treat diseases involving your pelvis. 

Conditions that can be treated using gynae laparoscopy include:

Uterine Fibroids

These are non-cancerous growths that develop from the muscle layer of the uterus and are commonly found in women from 30 to 50 years old. Fibroids can be single or multiple, have varying shapes and can cause symptoms such as heavy, long, painful periods, anaemia (low blood count), pressure symptoms (difficulty passing urine or motion), abdominal bloatedness, and depending on their location, miscarriages or infertility. 

Ovarian Cysts

There are many different types of ovarian cysts and not all cysts require treatment. Surgery is usually recommended if the ovarian cyst is large, causing symptoms or is suspicious for cancer. Large ovarian cysts can sometimes burst, bleed or cause the ovary to twist – called an ovarian cyst accident, this can result in severe pain, nausea, vomiting and fainting.

Adenomyosis

This is a condition where the tissue from the uterine lining grows into the muscle wall of the uterus; these tissues respond to hormonal changes and continue to bleed during periods, resulting in an enlarged swollen uterus and causing heavy, prolonged, painful periods and anaemia (low blood count) in severe cases.

Ectopic Pregnancy

Ectopic pregnancy is a pregnancy that occurs outside the uterus when a fertilized egg implants itself before reaching the uterus, most commonly in the fallopian tubes. An ectopic pregnancy is not a normal pregnancy and cannot be turned into one, as the only place that can sustain a pregnancy is the uterus. Ectopic pregnancies can rupture and cause massive, life-threatening internal bleeding – laparoscopic surgery in these cases can be life-saving.

Endometriosis

Endometriosis is a condition where tissue from the uterine lining is found outside the uterus. Gynae laparoscopy may be required if your symptoms are severe and/or uncontrollable with hormonal medications, or if your endometriosis is complicated by large ovarian endometriomas (“chocolate” cysts), or if you are facing problems getting pregnant.

Infertility

In some cases of female infertility, a gynae laparoscopy can be helpful to diagnose (and treat) certain causes of infertility, including pelvic adhesions, endometriosis, blocked or swollen fallopian tubes (hydrosalpinx) etc. In many cases, laparoscopy can be combined with hydrotubation, a dye test performed to determine fallopian tube patency.

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What happens during gynae laparoscopy?

Gynae laparoscopy is a minimally invasive surgery performed under general anaesthesia with a 1cm cut in the umbilicus and three to four 0.5cm cuts in the abdomen. A urine catheter will be inserted to drain your urine. The abdomen is inflated with carbon dioxide gas, and a laparoscope (camera) is inserted through the umbilicus with other instruments inserted through the smaller cuts, so as to perform the surgery. 

At the end of the operation, all specimens removed from you will be sent to the laboratory for testing, and the incisions stitched up. You will be given regular painkillers and in some cases, antibiotics as well during the initial recovery phase. Your gynaecologist will give you discharge advice and how to care for your wounds upon discharge.

How do I prepare for gynae laparoscopy?

Your gynaecologist may order imaging or blood tests before the procedure. You will be required to fast, and in some cases, some medications will need to be either omitted or taken before the surgery. 

In most cases of gynae laparoscopy, you will be asked to stay overnight or longer, depending on the nature and complexity of your case. 

Are there any side effects or risks of gynae laparoscopy? 

Gynae laparoscopy is generally a safe and commonly done procedure. Overall risk of complications is low but can be higher in certain conditions e.g. endometriosis, obesity, previous abdominal surgeries, previous infections, cancers – it is important that you discuss these with your gynaecologist.

Risks of laparoscopy include:

Common (affecting 1-5% of patients)
  • Shoulder tip pain
  • Wound bruising/ infection
  • Port site metastasis following cancer surgery (Cancer cells in the wound area)
  • Conversion to open surgery
Uncommon (affecting 0.1-1% of patients)
  • Hernia at the site of entry
  • Abdominal wall vascular injury
  • Absence of pathology / Negative laparoscopy
  • Major haemorrhage (Major bleeding)
  • Damage to bowel, bladder, ureter or uterus which would require additional procedures
  • Deep venous thrombosis (blood clot in the leg) or pulmonary embolism (blood clot in the lung)
  • Anaesthetic complications
Rare (affecting <0.1% of patients)
  • Major vessel injury
  • Brachial plexus neuropathy (nerve injury to the arm)
  • Pulmonary / Gas embolism (Gas bubble formation in lung vessels)
  • Pneumothorax / Pneumo-mediastinum (air in the spaces around the lungs)
  • Serious adverse reactions to general anaesthesia, including cardiorespiratory complications
  • Death: the risk is approximately less than 3-8 in 100,000.

How long does it take to recover after laparoscopy? 

If you have recently undergone a gynaecological surgery in Singapore, there are certain things to watch out for to aid your smooth recovery. Here are some things to note:

What to expect
  • Healing normally takes 2 to 6 weeks (depends on the surgery performed; laparoscopy usually faster than open)
  • Mild vaginal bleeding may last for 1 to 3 weeks; change your pad regularly
  • Wound/lower abdominal/pelvic discomfort; take your pain medications as prescribed for the first week
  • Feeling tired, especially for the first few days to a week after discharge
  • Some changes in urinary habits (e.g. frequency, urgency, tingling etc) and bowel movements
Wound Care
  • Wounds are closed by stitches and covered by skin glue or dressings (these are waterproof, so showers are allowed)
  • Most stitches are dissolvable. Some will need to be cut at your follow-up visit, together with removal of wound dressings
  • If wound dressings accidentally get wet, you may remove them
  • After showers, pat dry wounds gently with a clean towel
  • Wear your abdominal binder when sitting up/standing/walking (for open surgeries)
Medications
  • Continue your usual medications for your medical conditions e.g. diabetes, hypertension, cholesterol unless otherwise instructed by your doctor
  • Take your discharge medications as prescribed; you may reduce your pain medications after the 1st week as you improve over time
  • Complete your antibiotic course (if any)
Exercise
  • Do not stay in bed all day – you should walk around the house normally. After 1 to 2 weeks, gradually increase the walking distance. You may start gentle exercises if you feel up to it.

What can you not do after laparoscopic surgery?

For the first 6-8 weeks (or advised by your doctor): 

  • NO strenuous exercises such as running, aerobics, contact sports
  • NO swimming
  • NO sexual intercourse
  • NO heavy lifting (including shopping bags, laundry baskets, carrying children)
  • NO abdominal massages

Contact your doctor if you experience the following: 

  • Heavy vaginal bleeding (clots, or heavier than your usual periods)
  • Foul-smelling vaginal discharge or urine
  • Increasing abdominal pain that is not relieved by your pain medications
  • Abdominal bloating, vomiting
  • Difficulty or inability to pass motion/ gas or urine
  • High fever >38 degrees
  • Redness or pus coming from your wounds