Gynaecological laparoscopy: what happens, risks and recovery

The operation lets a gynaecologist see the outside of the womb, the fallopian tubes and the ovaries directly instead of inferring from a scan. NHS trust leaflets list long-standing pelvic pain, suspected endometriosis, pelvic infection, damaged tubes, an ectopic pregnancy, ovarian cysts and difficulty conceiving among the reasons. Because it can be diagnostic or operative, one visit may confirm the cause and treat it.

It is not usually the first step. Ultrasound, MRI and blood tests are normally tried before a surgical look, and some conditions, such as small cysts that are likely to settle, are watched rather than operated on. A laparoscopy is also not suited to everyone: a previous series of abdominal operations can leave scar tissue that makes access difficult, which is one reason a surgeon may warn that the plan could change on the day.

Follow the fasting instructions in your admission letter exactly. One trust leaflet warns that ignoring them may mean the operation is cancelled. A pregnancy test is checked before surgery, and the Plymouth leaflet asks people to use reliable contraception beforehand, so tell the team if a period is late.

Leaflets describe showering before arrival, avoiding shaving or waxing the lower tummy, and leaving jewellery and make-up at home. Bring a urine sample if asked and arrange a lift home, since you should not travel alone after an anaesthetic.

• Declare regular medicines, especially blood thinners and diabetes tablets, at pre-assessment.

• Ask whether treatment may be carried out if something is found, and sign consent for the possibilities you accept.

• Plan a quiet couple of days at home with someone nearby.

After the anaesthetist puts a drip in and you fall asleep, the surgeon makes a small cut near the navel. A leaflet from one trust describes this as 1 to 2 cm, another quotes 0.5 to 1 cm. Carbon dioxide gas is passed into the abdomen to lift the wall away from the organs, and a thin telescope with a light is inserted so the pelvis appears on a screen.

Further small cuts, two or three in all in one leaflet, let the surgeon introduce instruments to take samples, free adhesions, treat endometriosis, drain or remove a cyst, or check that dye flows through the tubes. When the work is finished the gas is released and the cuts are closed and covered.

You wake in recovery, are checked by nurses, and when pain and nausea are controlled you can usually go home within the day.

Common effects are tummy soreness, bruising around the cuts, bloating and shoulder-tip pain from retained gas, which the Hull and Milton Keynes leaflets say settles over about one to two days. Feeling sleepy or nauseous afterwards is also usual.

Serious complications are uncommon. The Hull leaflet quotes about 2 per 1,000 women with a serious problem, the Milton Keynes leaflet says fewer than 1 in 100, and the Plymouth leaflet gives about 1 in 200 for injury to the bowel, bladder or ureters and about 1 in 1,000 for conversion to open surgery. The differences come from how each trust counts, so ask your own surgeon for their figures. Other listed risks are infection, bleeding that may need a transfusion, blood clots, hernia at a cut and an operation that cannot be completed.

Dressings can usually come off after a day or two and the cuts are described as healing within about four to five days in one leaflet. Time off work is quoted at about five days in one leaflet, up to one week after a purely diagnostic look and two to three weeks after an operative one in another. Milton Keynes says full recovery can take 7 to 14 days or longer.

Sex can resume when it feels comfortable, and the Milton Keynes leaflet suggests avoiding vigorous exercise for two to four weeks. On driving, one leaflet says at least 48 hours and another 24 hours after the anaesthetic; the legal point is that you must be able to control the car and stop in an emergency, and you should check your insurer. GOV.UK adds that the DVLA must be told if you are still unable to drive three months after an operation.

Contact your GP, the hospital ward or NHS 111 if you notice burning when passing urine, a red and painful scar, a wound that is leaking, or tummy pain that is getting worse rather than better. Pain with vomiting or a fever needs same-day assessment.

A swollen, red or painful calf may be a clot and needs urgent review. Sudden breathlessness, chest pain or collapse is a 999 situation.

• Is this purely diagnostic, or may you treat things you find?

• What would make you stop or convert to a larger cut?

• Will you give me pictures or a written account of what you saw?

• When will I get results, and who will explain them?

• How soon can I try for a pregnancy, if that is my aim?

The technique is the same in both settings. What differs is how long you wait, whether you can choose your surgeon, and how many follow-up contacts are included. Ask in advance how results will be communicated and who deals with any problem once you are home, because that arrangement is not identical across providers.