If you're scheduled to have a laparoscopy for the diagnosis or treatment of endometriosis, you might be wondering what is ahead.
It's understandable to feel nervous about the procedure, especially if it's your first time, says Donna Ciccia, director and cofounder of Endometriosis Australia.
Feeling prepared can help, so we asked Ms Ciccia and Dr Marilla Druitt, member of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, for their expertise and advice.
What is a laparoscopy?
A laparoscopy, also known as key-hole surgery, is a surgical procedure used to inspect, and operate on, the organs inside the abdomen and pelvis.
It's known as 'minimally invasive' surgery with smaller cuts, less pain, and quicker recovery time than other types of surgery, so is less taxing on the body.
Why laparoscopic surgery for endometriosis diagnosis and treatment?
While recent advancements mean some specialised clinicians can "rule in" endometriosis with imaging, says Ms Ciccia, a laparoscopy remains the only way to confirm a diagnosis.
If endometriosis can be seen during the laparoscopy, often it can be removed at the same time.
Other conditions can also be ruled out or diagnosed.
Dr Druitt says a sample of the endometriosis will often be sent for examination to confirm the diagnosis (unless on ovaries or places inappropriate to resect from).
What happens during a laparoscopy for endometriosis?
The operation takes place under general anaesthetic.
A "skinny camera" (called a laparoscope) about 0.5 centimetres in diameter is put through small cuts in the abdomen, explains Dr Druitt.
The abdomen is filled with carbon dioxide gas, which allows the surgeon to see the organs more clearly.
"We can inspect the uterus, tubes, ovaries and peritoneal surfaces, and the outside of the bowel," she says.
Surgeons are looking for abnormal deposits of endometrial tissue, scarring, or cysts.
At the end of the laparoscopy, the laparoscope and instruments are removed, the gas is let out, and the incisions are closed with stiches or glue.
The number of incisions made, how long it takes, and what is removed during the surgery — and where from — will all depend on your individual case, Dr Druitt says.
It's usually a day procedure but some patients may stay overnight.
How can you best prepare ahead of a laparoscopy?
Listening to the advice of your doctor is important.
What they advise for the days leading up to the surgery, whether that's around diet or bowel preparation, for example, may differ depending on the surgeon and your case, says Ms Ciccia.
"Have a chat to your doctor and your anaesthetist. If you're nervous, tell them that — they can help," she says.
Ask questions if you aren't sure about something. If you're worried you will forget, write them down.
In terms of pain management, Dr Druitt says the more things you can do to decrease your pain before the operation, "the less pain you will have after".
Examples she shares include getting good sleep and regular exercise.
Let work or university know you will likely need a week off, although some may feel up to usual tasks before that time, says Dr Druitt, while others may need six weeks to recover.
Ms Ciccia says it's important to flag with your support network that you may need help with childcare and other duties while you are recovering.
You will need someone to drive you home from hospital, for example.
She recommends joining Endometriosis Australia's closed Facebook group where patients share their tips with each other.
While most patients can go home the same day as surgery, it doesn't hurt to pack on overnight bag in case you need to stay.
You should also have a follow-up appointment with your surgeon booked to discuss results in depth, and any further treatment plans.
What is laparoscopy recovery like?
Dr Druitt says it's safe to resume daily living activities when you feel OK to do so, usually a few days after surgery. She adds movement that feels achievable and comfortable can help you feel better.
Ms Ciccia says to be kind to yourself, however, and don't be in a rush to "run a marathon".
"I think it really depends [on your individual circumstances] on what recovery will look like — be gentle on yourself."
Dr Druitt recommends small meals during the first few days of recovery, and foods that are easier on the digestive system.
Items you might like to have prepared for recovery suggested by our experts include:
- Panty liners to period underwear to manage light bleeding
- Soft underwear and pants that don't dig into your stomach
- Over-the-counter painkillers such as paracetamol and ibuprofen
- Fresh sheets on the bed or a warm blanket on the couch where you will spend recovery, with water, snacks, and entertainment nearby.
This is general information only. For detailed personal advice, you should see a qualified medical practitioner who knows your medical history.
