Surgical Procedures

Laparoscopy is a surgery that uses a thin, lighted tube put through a cut (incision) in the umbilicus (belly button) to look at the abdominal organs or the female pelvic organs. This technique is used to diagnose and treat problems such as cysts, adhesions, fibroids and infection.

During the operation the surgeon watches detailed images of the abdomen on the monitor. Through another 2- 3 small cuts (usually about 0.5 cm), specialised instruments allow the surgeon to perform the same operations as traditional surgery but with smaller incisions.

Recovery is much better as compared to open surgery with less pain, and there as less long term complications eg adhesions (internal scarring) and infection.

In the hands of a well-trained surgeon, laparoscopic approach for early cancers of the ovary, uterus and cervical cancer is acceptable alternative to laparotomy. It has the advantage of better recovery, especially important if further treatment with chemotherapy or radiotherapy is needed. Not all patients are suitable for this approach – the decision is usually made after the doctor has reviewed your initial reports and scans.

Laparoscopic surgery is as safe as traditional open surgery. In about 1 % of cases, the surgeon may need to make a larger incision in order to complete the operation safely if there are factors that prevent a clear view of the structures eg previous scarring or inflammation.

The risk of any operation is determined in part by the nature of the specific operation. An individual’s general heath and other medical conditions are also factors that affect the risk of any operation. You should discuss with your surgeon your individual risk for any operation.

Loop electrosurgical excision procedure (LEEP) uses a wire loop heated by electric current to remove cells and tissue as part of the diagnosis and treatment for abnormal or cancerous conditions in a woman’s lower genital tract.

LEEP may be performed when cervical or vaginal problems are found during a pelvic examination, or abnormal cells are found during a Pap test. LEEP is also performed to detect cancer of the cervix or vagina.

Cells that appear to be abnormal, but are not cancerous at the present time, may be identified as precancerous. The appearance of these abnormal cells may be the first evidence of cancer that could develop years later.

• Polyps (benign growths)
• Genital warts, which may indicate infection with human papilloma virus (HPV), a risk factor for developing cervical cancer
• Diethylstilbestrol (DES) exposure in women whose mothers took DES during pregnancy, as DES exposure increases the risk for cancer of the reproductive system

There may be other reasons for your health care provider to recommend LEEP.

• Infection
• Bleeding
• Changes or scarring in the cervix from removal of tissue
• Difficulty getting pregnant
• Potential for preterm birth or having a low birth weight baby

Patients who are allergic to or sensitive to medications, iodine, or latex should notify their health care provider.

If you are pregnant or suspect that you may be pregnant, you should notify your health care provider.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your health care provider prior to the procedure.

• Generally, no prior preparation, such as fasting or sedation, is required
• If you are pregnant or suspect that you are pregnant, you should notify your health care provider
• Notify your health care provider of all medications (prescribed and over-the-counter) and herbal supplements that you are taking
• Notify your health care provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure
• LEEP is usually performed when you are not having your menstrual period
• Your health care provider may recommend that you take a pain reliever 30 minutes before the procedure
• You may want to bring a sanitary napkin to wear home after the procedure
• Based on your medical condition, your health care provider may request other specific preparation

• You will be asked to undress completely or from the waist down and put on a hospital gown
• You will be instructed to empty your bladder prior to the procedure
• You will lie on an examination table, with your feet and legs supported as for a pelvic examination
• Your health care provider will insert an instrument called a speculum into your vagina to spread the walls of the vagina apart to expose the cervix
• Often, the health care provider will use a colposcope, an instrument with a special lens similar to a microscope, to magnify the tissues. The colposcope will be placed at the opening of your vagina but does not enter your vagina
• Your health care provider will look through the colposcope to locate any areas for treatment on the cervix or in the vagina. Photographs with the colposcope or sketches of the areas on your cervix may be made for your health care record
• Your cervix may be cleansed and soaked with a vinegar solution, also called acetic acid solution. This helps make the abnormal tissues turn white and become more visible. You may feel a mild burning sensation. An iodine solution is sometimes used to coat the cervix, called the Schiller test
• The health care provider will numb the area using a small needle to inject medication
• A type of forceps, called a tenaculum, may be used to hold the cervix steady for the procedure. You may feel some cramping when the tenaculum is applied
• You will hear humming and/or blowing sounds from the equipment
• The LEEP wire will be inserted through the speculum and passed through the abnormal tissues. One or more passes may be needed. You may feel pressure or a slight cramping
• It is very important that you lie still during the procedure
• The amount and location of tissue removed depends on the whether LEEP is being used as a diagnostic tool, or to remove abnormal tissue. LEEP wires come in different sizes and shapes
• The electrical current will act as a cautery to seal the blood vessels, so usually there is very little bleeding. Any bleeding from the LEEP site may be treated with a paste-like topical medication
• The tissue will be sent to a lab for further examination

After LEEP, you may rest for a few minutes after the procedure before going home. You may want to wear a sanitary pad for bleeding. It is normal to have some mild cramping, spotting, and dark or black-colored discharge for several days. The dark discharge is from the medication applied to your cervix to control bleeding.

You may be instructed not to douche, use tampons, or have intercourse for four weeks after LEEP, or for a period of time recommended by your health care provider.

You may also have other restrictions on your activity, including no strenuous activity or heavy lifting.

Take a pain reliever for cramping or soreness as directed by your health care provider. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Your health care provider will advise you on when to return for further treatment or care. Generally, women who have had LEEP will need more frequent Pap tests.

• Bleeding with clots
• Foul-smelling drainage from your vagina
• Fever and/or chills
• Severe abdominal pain

Your health care provider may give you additional or alternate instructions after the procedure, depending on your particular situation.