Laparoscopic Surgery When Endometriosis is Suspected
Why would you be having laparoscopic surgery?
Laparoscopic surgery (often referred to as “lap”) is the only real way to diagnose endometriosis. Your gynecologist or even family doctor may have made an assumptive diagnoses based on your symptoms, but a true diagnoses can only be made when the endometrial adhesions are seen. The description of the surgery (-scopic) suggests that the doctor intends to merely look and see if adhesions are present, but once adhesions are found they are removed during the same procedure. Endometrial adhesions are most frequently found on the ovaries and fallopian tubes, but may be present anywhere in the abdomen. Endometriosis on the ovaries can form cysts, called endometrioma.
What you can expect
You will need somebody with you, whom must remain at the hospital throughout your procedure to drive you home.
Each hospital will have its own standard operating procedures (SOP), I can only write from my experience, using the SOP of my hospital. Your lap will be performed in a hospital by a gynecologist as an outpatient surgery. You will be placed under general anesthesia for the procedure. You will be asked to follow their standard pre-op procedures, such as fasting the night before. Beforehand you will have an IV started and provide a urine sample for a pregnancy test. The doctor will brief you on his/her plan for the surgery and what will be done if adhesions are found. The anesthesiologist will also speak to you about the anesthesia that will be used and the endotracheal tube (the breathing tube they put in). A few minutes prior to being moved to the operating room you will be given a shot of a medication in the category benzodiazepines, most likely midazolam (brand name- Versed). This medication is a relaxant and also an amnesic (reduces your memory of events while on the medication). You may begin to feel drowsy and “stoned,” which is normal for this medication. Once you are in the operating room and transferred to the operating table, additional medications will be administered and once you are completely unconscious a breathing tube will be placed in your throat.
A small incision is made in your abdomen to facilitate the insertion of the laparoscope. There is a camera on the laparoscope that allows the doctor to see your internal organs without making a large incision. Another incision, this one much smaller, is made to allow a tube to be inserted. Sterile air is pushed through this tube into your abdomen. Once your abdomen is inflated, the doctor can see the entire area much easier and access areas that would have otherwise been blocked from view. The doctor will basically look around for anything out of the ordinary. Endometrial lesions and endometrioma will be removed with a laser, but also shifted ovaries can be returned to the correct position and anchored, and likely many other beneficial procedures. The doctor will take many pictures, both before and after shots, for your patient file.
Once the surgery is complete, the air is released and your abdomen deflates. The incisions are sealed externally with glue, probably stitches internally, but for the life of me I can’t remember what they said (that darn Versed). The breathing tube is removed and a medication is administered to slightly reverse the affects of the anesthesia. You will be moved to the recovery area until you become more fully conscious, and then returned to the outpatient area that you started in. The doctor will then come speak to you about the surgery: what was found, what was done to treat it, your prognosis, etc. You will be given a prescription for painkillers, and if you are in pain (anesthesia is very much different from painkillers) you will be given a dose of the medication prescribed. Once you are able to sit up and feel ready to leave, you will be taken by wheelchair to the car.
You will be under restrictions for 2 weeks following your surgery. Abdominal surgery requires cutting abdominal muscles, and the abdomen is your core, it is used when moving almost any part of your body. The restrictions are in your best interests, and in the best interests of your healing body.
Problems that may arise and ways to troubleshoot
You may notice pain or cramping in your neck, shoulders, or upper arms for a few days following surgery. This pain is a result of the trapped air from the inflation of your abdomen. Some air gets trapped and is not released when your abdomen deflates. This air “floats” in your body, moving to the highest part of your body. Lying as flat as possible, or with your legs elevated will disperse this trapped air, spreading it out and not allowing it to concentrate in one area. The air is gradually absorbed into your blood stream and released within a few days. A way to encourage that absorption is a heating pad and/or massage. When the area has a greater blood flow the trapped air is absorbed faster.
As with all surgeries, your incisions are very important. If they become more painful, red, swollen, or begin producing a discharge, see your doctor immediately.
My personal tips
My procedure took an incredibly long time due to the amount of adhesions I had and where they were located (one ovary was ripped from its proper location with an endometrioma, minor adhesions on the bladder, lots of adhesions everywhere), but was not difficult at all. When I was awake, though, I did notice an odd taste in my mouth (from the breathing tube) and my mouth felt incredibly dry. Be sure to have a nice cool bottle of water nearby once you get home (or for the drive if it’ll last longer than 10-15 minutes).
The person who drives you should be somebody you trust enough to have with you when the doctor comes to give you the post-op report. You will likely be very groggy (I don’t remember seeing my doctor afterwards, but I’m told he was around for 10-15 minutes telling my husband about everything). This person should also be taking notes, because you will want every detail and their memory may not be perfect enough for your liking if they don’t write it all down.
The trapped air was my biggest complaint afterwards, and the painkillers I got (darvocet) did nothing for that pain. Apparently the main use of darvocet is for incision pain, of which I had almost none. Needing darvocet was my downfall, but I’m allergic to vicodin (apparently their drug of choice post-surgery). I ended up taking either Tylenol or Advil liquigels for the air bubble pain, whichever was closest to the couch. My husband was nice enough to give me twice-daily shoulder rubs and keep my microwavable heat pad nice and warm for me. The pain lasted 3 days, including the day of surgery, but after the second day it was more like the pain of an overworked muscle.
My main incision was less than an inch long, inside the bottom of my belly button. It felt like a cat scratch, and within a week I didn’t feel anything at all. The second incision was un-located for 2 entire days, as it was located below the pubic hair line and caused absolutely no discomfort. The only time I had any pain in my main incision was during the process of changing positions (i.e. sitting to standing and its inverse, rolling over, etc.).
Don’t wear a belt for a while, especially one with a big, cute buckle. Pressure on that navel incision is not a good idea; it hurts. All of my pants are low-rise, but sitting down or bending over with a belt on pushes the buckle right into that incision.
Restrictions exist for a reason. You use your stomach to wiggle your toes and pick up your head off the pillow, and just about everything else. The 20lb lifting restriction extends to the vacuum cleaner, even if you’re just pushing and pulling it across the carpet. Take advantage of your restrictions, they really are in your best interests. I was back to basically my normal routine about
4-5 days after my surgery, except for strictly following the restrictions. Once my restrictions were lifted I had no problem going back to that routine, including shoveling 2 feet of snow in my driveway. You know your body best, you know how slowly to ease into things once the restrictions are lifted. But don’t rush the restrictions, they were put in place by somebody who has seen your insides, and if you trust them enough to let them cut you open you need to trust their judgment on restrictions as well.