Everyday, hundreds of women in Australia undergo surgery for treatment of pelvic disease. Until recently, this would mean open surgery (laparotomy) for treatment of common problems such as urine incontinence, endometriosis, ovarian cysts, muscle growths of the uterus (fibroids) or for removal of a diseased uterus itself (hysterectomy).
What is Open Surgery?
Open surgery means a large incision in the abdomen to expose the area of the body on which the operation is to be performed. Much of the postoperative pain is due to this large incision. As a result, you often need to stay in hospital for some five to seven days and may require some six weeks of convalescence before you feel able to return to normal activities. In addition to the disruption this may cause to your family life and employment, open surgery also carries risks of adhesions and infection because of the exposure of body tissue to the external environment. Is there an alternative to Open Surgery?
Laparoscopic or keyhole surgery, eliminates the need for the large incision and is a safe and effective alternative to open surgery.
What happens in key hole surgery?
With keyhole surgery, a viewing telescope attached to a camera and light source (the laparoscope) is passed through a specially designed tube into the abdomen, allowing the surgeon to see the operative area on a video monitor.Two or three other small incisions are made to create passageways for specially designed surgical instruments which help the doctor to carry out the same types of procedures as in open surgery.
Conditions suitable for keyhole surgery:
• Uterine bleeding disorders
• Hysterectomy
• Pelvic floor and vaginal prolapse
• Urinary incontinence
• Endometriosis
• Ovarian cysts
• Fibroids
• Reproductive or tubal surgery
• Severe period pain
• Adhesions
• Some early pelvic cancer
The benefits of keyhole surgery:
Because the incisions are much smaller, pain can be significantly reduced with less need for postoperative pain medication. Less pain means shortened hospital stays and a faster recovery. In many instances, this means recovering in the comfort of your own home with surrounding family members and friends, and being able to resume employment within a few weeks. In addition to the better cosmetic healing of smaller incisions, keyhole surgery also reduces the risk of adhesions and infection because tissues inside the abdomen are not directly exposed to the outside.
Risks and complications:
The risks associated with this form of surgery are uncommon but they include:
• Side effects due to anaesthesia such as nausea
• Infection
• Bleeding
• Leg vein thrombosis
• Injury to nearby organs such as bowel, bladder or ureter, requiring further surgery
• Complications related to laparoscopy such as damage to blood vessels, bowels, portsite hernia
• Conversion to open surgery in case of unexpected complication or finding such as malignancy
What happens before surgery?
Before surgery, your doctor will explain the condition which affects you and the likely outcome of non-treatment and treatment alternatives. Where surgery is the solution, the indication, the risks and benefits of surgical treatment will be discussed, in particular if your condition is suitable for keyhole surgery, and the ideal time within which your planned surgery should take place. You should take time to consider the recommendation and, if you wish ask for other expert opinions before making a decision to proceed.
Once you decide to undergo surgery, you will need to sign the consent form for the recommended treatment and admission paper for hospital admission. Keyhole surgery is normally performed under general anaesthesia. This means you will be asked not to eat or drink anything for six hours before surgery. On admission, you will be seen by a member of the nursing staff and the anaesthetist. Please inform your doctors of any allergy or past anaesthetic problems.
What to expect following the operation?
Recovery following the operation depends upon the type of procedure you have undergone. Generally, you may experience some of the following symptoms which may last for a day or two:
• Pain at the site of the incisions
• Shoulder tip pain from the gas used
• Abdominal bloating sensation
• Mild nausea related to anaesthesia
• Mild vaginal bleeding or discharge
Recovery at home:
Following discharge from hospital, avoid strenuous exercises for about a week. Remove the bandages from the incisions the day after surgery. Apply an antiseptic solution and leave them exposed to dry. You will be advised if the sutures will dissolve on their own or if they need to removed.
Use sanitary pads, not tampons, to avoid infection. Vaginal bleeding will usually settle within a few days. You may resume sexual activity as soon as it is comfortable for you, unless otherwise directed by your doctor.
Please notify your surgeon, your family doctor or the hospital you attended if you have:
• Severe or increasing pain
• Fever
• Nausea or vomiting
• Persistent or heavy bleeding
• Redness, swelling or discharge from the incisions
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