Laparoscopic Surgery

Our Laparoscopic Surgery Services offer minimally invasive surgical solutions for a wide range of gynaecological conditions. Using advanced keyhole techniques, we can diagnose and treat conditions with smaller incisions, less pain, and faster recovery compared to traditional open surgery.

What Is Laparoscopic Surgery?

Laparoscopic surgery (also called keyhole surgery or minimally invasive surgery) is a surgical technique where operations are performed through small incisions (usually 0.5-1.5 cm) using a camera and specialised instruments.

How It Works

1. Small incisions are made in the abdomen (usually 2-4)
2. Carbon dioxide gas is used to inflate the abdomen, creating space to operate
3. A laparoscope (thin camera) is inserted to visualise the pelvic organs
4. Specialised instruments are used to perform the surgery
5. The incisions are closed with dissolvable stitches or surgical glue

Benefits of Laparoscopic Surgery

Our Laparoscopic Procedures

Diagnostic Laparoscopy

What is it? Diagnostic laparoscopy is a procedure to examine the pelvic organs directly when other tests haven’t provided a clear diagnosis.

When is it recommended?

• Investigation of chronic pelvic pain
• Suspected endometriosis
• Unexplained infertility
• Assessment of pelvic masses
• Evaluation of congenital abnormalities

What happens during the procedure?

• A small incision is made near the umbilicus (belly button)
• The laparoscope is inserted to examine the uterus, ovaries, fallopian tubes, and surrounding structures
• Photographs or video may be taken for documentation
• Biopsies can be taken if needed
• Treatment can often be performed at the same time

Recovery:

• Usually a day-case procedure
• Mild discomfort and bloating for a few days
• Return to normal activities within 1-2 weeks

Ectopic Pregnancy Surgery

What is an ectopic pregnancy? An ectopic pregnancy occurs when a fertilised egg implants outside the uterus, most commonly in the fallopian tube. This is a potentially life-threatening condition that requires urgent treatment.

Symptoms of ectopic pregnancy:

• Missed period with positive pregnancy test
• One-sided abdominal or pelvic pain
• Vaginal bleeding or spotting
• Shoulder tip pain
• Dizziness, fainting, or collapse (emergency signs)

Surgical options:

Salpingectomy (tube removal):

• Removal of the affected fallopian tube
• Recommended when the tube is severely damaged
• Does not significantly reduce future fertility (remaining tube compensates)
• May be preferred if you have completed your family

Salpingotomy (tube-sparing surgery):

• The ectopic pregnancy is removed while preserving the tube
• Considered when preserving fertility is important
• Small risk of persistent ectopic tissue (requires follow-up)
• May be preferred if you have only one tube or previous tubal damage

Emergency surgery:

• If the ectopic has ruptured, emergency surgery is required
• May need to be performed as open surgery if there is significant bleeding
• Blood transfusion may be necessary

Recovery:

• Hospital stay: 1-3 days depending on complexity
• Physical recovery: 2-4 weeks
• Emotional support available throughout

Ovarian Cyst Surgery

When is surgery needed? Not all ovarian cysts require surgery. Surgery may be recommended for:

• Large cysts (usually >5-6 cm)
• Cysts causing symptoms (pain, pressure)
• Cysts with concerning features on ultrasound
• Cysts that don’t resolve on their own
• Suspected endometriomas
• Dermoid cysts (teratomas)

Types of surgery:

Ovarian cystectomy:

• Removal of the cyst while preserving the ovary
• Preferred approach, especially for women wanting future fertility
• The ovary heals and continues to function normally

Oophorectomy:

• Removal of the entire ovary
• May be necessary for very large cysts, torsion, or concerning features
• The remaining ovary compensates for hormone production

What to expect:

• Usually 2-3 small incisions
• Day-case or overnight stay
• Cyst sent for laboratory analysis
• Results discussed at follow-up appointment

Recovery:

• Return to light activities: 1 week
• Return to normal activities: 2-3 weeks
• Avoid heavy lifting for 4-6 weeks

Adhesiolysis (Adhesion Removal)

What are adhesions? Adhesions are bands of scar tissue that form between organs and tissues in the abdomen and pelvis. They can cause organs to stick together, leading to pain and other complications.

Causes of adhesions:

• Previous surgery (most common cause)
• Endometriosis
• Pelvic infections
• Appendicitis
• Inflammatory conditions

Symptoms:

• Chronic pelvic pain
• Pain during intercourse
• Infertility (if fallopian tubes are affected)
• Bowel obstruction (in severe cases)

Laparoscopic adhesiolysis:

• Careful division of adhesion bands
• Restoration of normal anatomy
• Release of trapped organs
• Improved mobility of pelvic structures

Benefits:

• Reduced pain
• Improved fertility potential
• Better organ function
• Prevention of complications

Considerations:

• Adhesions can recur after surgery
• Barrier agents may be used to reduce recurrence
• Severity of adhesions affects surgical complexity

Laparoscopic Myomectomy

What is it? Laparoscopic myomectomy is the removal of uterine fibroids while preserving the uterus. This is an important option for women who wish to maintain fertility.

When is it suitable?

• Symptomatic fibroids causing heavy bleeding, pain, or pressure
• Fibroids affecting fertility
• Women who want to preserve their uterus
• Fibroids suitable for laparoscopic removal (size and location)

The procedure:

• Fibroids are identified and carefully removed from the uterine wall
• The uterine defect is repaired with sutures
• Specimens are removed through a small incision or morcellator

Recovery:

• Hospital stay: 1-2 days
• Return to work: 2-4 weeks
• Avoid pregnancy for 3-6 months (to allow uterus to heal)

Considerations:

• Multiple or very large fibroids may require open surgery
• Risk of fibroid recurrence
• Future pregnancies may require caesarean section (depending on surgical technique)

Laparoscopic Hysterectomy

What is it? Laparoscopic hysterectomy is the removal of the uterus using keyhole surgery. This offers significant advantages over traditional open abdominal hysterectomy.

Types of laparoscopic hysterectomy:

When is hysterectomy recommended?

• Heavy menstrual bleeding not responding to other treatments
• Uterine fibroids causing significant symptoms
• Adenomyosis
• Endometriosis (severe cases)
• Uterine prolapse
• Chronic pelvic pain
• Gynaecological cancers (may require additional procedures)

Benefits of laparoscopic approach:

• Smaller incisions (3-4 small cuts vs one large abdominal incision)
• Less post-operative pain
• Shorter hospital stay (1-2 days vs 3-5 days)
• Faster recovery (2-4 weeks vs 6-8 weeks)
• Lower risk of infection and complications
• Better cosmetic result

The procedure:

1. Small incisions made in the abdomen
2. Uterus detached from supporting structures
3. Blood vessels secured
4. Uterus removed through the vagina or via morcellation
5. Vaginal cuff closed with sutures

Recovery timeline:

• Hospital stay: 1-2 nights
• Light activities: 1-2 weeks
• Driving: 2-3 weeks (when comfortable)
• Return to work: 2-4 weeks (depending on job)
• Full recovery: 4-6 weeks
• Avoid heavy lifting and intercourse: 6 weeks

Surgery for Endometriosis

Laparoscopic treatment options:

Excision of endometriosis:

• Cutting out endometriosis deposits
• Gold standard treatment
• Preserves tissue for diagnosis
• More thorough removal

Ablation of endometriosis:

• Burning or destroying superficial deposits
• Suitable for minimal disease
• Quicker procedure

Treatment of endometriomas:

• Drainage and removal of ovarian chocolate cysts
• Careful technique to preserve ovarian tissue

Treatment of deep infiltrating endometriosis:

• Complex surgery for advanced disease
• May involve bladder, bowel, or ureter
• Multidisciplinary team approach when needed

Benefits:

• Pain relief
• Improved fertility
• Accurate diagnosis and staging
• Tissue for histological confirmation

Before Your Surgery

Pre-operative assessment

• Medical history review
• Blood tests
• Examination
• Discussion of procedure, risks, and alternatives
• Consent process
• Anaesthetic assessment if required

Preparation instructions

• Fasting before surgery (usually from midnight)
• Medications to continue or stop
• What to bring to hospital
• Arrange transport home
• Plan for recovery period

After Your Surgery

Immediately after

• Recovery room monitoring
• Pain relief provided
• Assessment before discharge
• Post-operative instructions given

At home

Normal experiences:

• Mild to moderate abdominal discomfort
• Shoulder tip pain (from gas used during surgery) — usually resolves in 24-48 hours
• Bloating
• Fatigue
• Small amount of vaginal bleeding

Warning signs — contact us if you experience:

• Fever (temperature >38°C)
• Severe or worsening pain
• Heavy vaginal bleeding
• Inability to pass urine
• Signs of wound infection (redness, swelling, discharge)
• Nausea and vomiting preventing eating/drinking

Recovery tips

• Take prescribed pain relief regularly
• Move around gently to prevent blood clots
• Avoid heavy lifting for 4-6 weeks
• Avoid intercourse until advised (usually 4-6 weeks for hysterectomy)
• Gradually increase activity levels
• Attend follow-up appointments

Risks and Complications

As with any surgery, laparoscopic procedures carry some risks:

General risks:

• Anaesthetic complications
• Bleeding
• Infection
• Blood clots (DVT/PE)
• Wound complications

Specific to laparoscopy:

• Conversion to open surgery (if laparoscopy not possible)
• Injury to surrounding organs (bowel, bladder, blood vessels)
• Subcutaneous emphysema (gas under skin)
• Port-site hernia

These risks are generally lower with laparoscopic surgery compared to open surgery. We will discuss specific risks relevant to your procedure during your consultation.

Frequently Asked Questions

How long will I be in hospital? Most laparoscopic procedures are day-case or require one overnight stay. Complex procedures like hysterectomy typically require 1-2 nights.

When can I return to work? This depends on the procedure and your job:

• Desk job: 1-2 weeks (minor procedures), 2-4 weeks (major procedures)
• Physical job: 4-6 weeks

Will I have scars? Laparoscopic surgery uses small incisions (0.5-1.5 cm) that heal well and are usually barely visible after a few months.

Can all gynaecological surgery be done laparoscopically? Many procedures can be done laparoscopically, but some conditions (very large fibroids, advanced cancer, severe adhesions) may require open surgery. We will advise on the best approach for your situation.

Is laparoscopic surgery safe? Yes. Laparoscopic surgery is a well-established technique with an excellent safety record. In many cases, it’s safer than open surgery due to smaller incisions and faster recovery.

Book a Consultation

If you’ve been advised to consider surgery or would like to discuss your treatment options, our team is here to help. Contact us at info@salamivf.com or call +973 1725 5095 to schedule a consultation.