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How is endometriosis diagnosed: what will happen when i have my laparoscopy HOW IS ENDOMETRIOSIS DIAGNOSED: WHAT WILL HAPPEN WHEN I HAVE MY LAPAROSCOPY
When you have your laparoscopy you will be in hospital for one or two days. An increasing number of hospitals are now doing laparoscopies as a day procedure, which means that you will be admitted early in the morning and discharged later the same day.
After you have been admitted to the ward a medical history will usually be taken, your pubic hair may be shaved and the anaesthetist will probably visit you. You will also be given a consent form so you can sign your permission for the operation. You may already have signed the consent form when you discussed the operation with your gynaecologist at an earlier visit.
Before the operation you will not be allowed to eat or drink for at least six hours, and you will be asked to shower and empty your bladder not long before you are due to go to the operating theatre. About an hour before the operation you may also be given an injection, often referred to as a pre-med or a pre-medication, that may make you relaxed and sleepy and will probably make your mouth feel dry.
The operation will be performed under a general anaesthetic and it usually takes 20 to 60 minutes depending on the severity of your endometriosis and whether or not any treatment is done at the time.
When you go into the operating theatre you will be given the general anaesthetic which is injected into a vein in your hand or arm. A tube will be placed in your throat and connected to a machine that breathes for you. You will then be positioned on the operating table so that your head is tilted downwards and lies below the level of your hips. This position is necessary so that the bowel falls away from the pelvic organs and a clearer view can be obtained when the laparoscope is used. A tube may also be inserted into your bladder to drain the urine.
You will be given a pelvic examination and then a D&C will be performed if it has been scheduled. During the D&C your cervix will gradually be opened with a series of instruments, known as dilators, and the lining of the uterus will be scraped off.
An instrument known as a cannula will then be inserted into the opening of your cervix. The cannula allows the gynaecologist to gently move the uterus around during the operation.
A small cut of two to three centimetres will then be made just below, or in the fold of, your navel and a needle inserted. Approximately two to six litres of carbon dioxide gas will then be slowly pumped into your abdomen through this needle. The gas causes the organs in the abdomen and pelvis to lift and separate from each other so that they can be seen more clearly. The needle will then be removed and the laparoscope inserted into the cut.
The gynaecologist will usually make a second small cut just above the pubic hairline so that an instrument, known as a probe, can be inserted and used to move the internal organs around as necessary. Still another cut may be made midway between the navel and the pubic hairline to remove samples of tissue or drain fluid from any cysts.
The gynaecologist will then carry out a thorough inspection of the entire pelvic cavity for traces and signs of endometriosis — in the obvious and the not so obvious places. The probe inserted through the pubic hairline cut and the cannula in the cervix will be used to lift and move the uterus and ovaries around so that their undersurfaces can be clearly viewed.
The gynaecologist will be able to see any implants of endometriosis ranging in size from pinhead-sized spots to large cysts and endometriomas as well as any adhesions and areas of inflammation. If classical endometrial implants and cysts are visible their appearance will usually be sufficient for the gynaecologist to make a definite diagnosis of endometriosis immediately. If atypical implants are present, or if there are no obvious visible implants, it may be necessary to remove one or more tiny samples of tissue, known as a biopsy, from any suspicious areas for later examination and testing under a microscope.
If fertility problems exist, dye may be passed through the tubes to see if they are blocked.
When the examination has been completed and the details recorded, the laparoscope and other instruments will be removed and the carbon dioxide gas will be forced out of the abdomen in much the same way that one deflates a rubber ball. The cuts will then be stitched or stapled and you will be taken to the recovery room and soon afterwards back to your hospital room.
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