Name of the Procedure:

Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method
Common name(s): Laparoscopic excision or fulguration of ovarian or pelvic lesions, Minimally invasive ovarian surgery

Summary

Laparoscopy with fulguration or excision is a minimally invasive surgical procedure used to remove or destroy lesions on the ovary, pelvis, or peritoneal surfaces. It involves making small incisions in the abdomen and using specialized instruments to either cut out (excise) or destroy (fulgurate) abnormal tissue.

Purpose

This procedure is used to treat various conditions such as ovarian cysts, endometriosis, pelvic adhesions, and other pelvic or peritoneal lesions. The goals are to alleviate pain, improve fertility, remove problematic tissues, and prevent the progression of the disease.

Indications

• Chronic pelvic pain
• Suspicion of or diagnosed ovarian cysts
• Endometriosis causing pain or infertility
• Pelvic adhesions causing discomfort or bowel obstruction
• Unexplained infertility suspected to be due to pelvic lesions

Preparation

• Patients are usually advised to fast for at least 8 hours before the procedure.
• Pre-operative blood tests and imaging studies may be required.
• Adjustments to current medications, such as blood thinners, may be necessary.

Procedure Description

1. The patient is placed under general anesthesia.
2. A few small incisions are made in the abdomen.
3. A laparoscope (a thin tube with a camera) and other surgical instruments are inserted through these incisions.
4. The surgical instruments are used to locate and either excise (cut out) or fulgurate (destroy using an electric current) the lesions.
5. The instruments are removed, and the incisions are closed with sutures or surgical tape.

Duration

The procedure typically takes between 1 to 3 hours, depending on the complexity and extent of the lesions.

Setting

The procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon (typically a gynecologist or general surgeon with specialized training)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the incision sites
• Bleeding or damage to surrounding organs
• Adverse reactions to anesthesia
• Formation of scar tissue
• Persistent or recurrent pain

Benefits

• Relief from pain and discomfort caused by pelvic lesions
• Preservation or improvement of fertility
• Minimal scarring due to small incisions
• Shorter recovery time compared to open surgery

Recovery

• Most patients go home the same day or the day after surgery.
• Pain and discomfort at the incision sites can be managed with prescribed pain medications.
• Patients are usually advised to avoid heavy lifting and strenuous activities for a few weeks.
• Follow-up appointments are necessary to monitor recovery and ensure the effectiveness of the procedure.

Alternatives

• Medical management with medications such as hormonal treatments for endometriosis
• Open (traditional) surgery, which involves larger incisions and longer recovery times
• Conservative management with pain relief and monitoring

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Post-procedure, the patient may experience discomfort or pain at the incision sites, bloating, and mild abdominal pain. Pain management strategies, including medication and rest, can greatly enhance comfort.