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Gynecological operations using a laparoscopy

Important NOTE:
The description of the interventions was compiled with the greatest care. However, it can only be an overview and does not claim to be complete. The websites of the service providers and the personal consultation with the doctor or the surgical explanation in the respective operating facility provide further information.
The persons responsible for the content of this website do not guarantee the completeness and correctness of the information, as constant changes, further developments and specifications are made as a result of scientific research or adaptation of the guidelines by the medical societies.

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The gynecologists were the first to actually realize the possibility of laparoscopy on a larger scale and have been practicing it for decades. The introduction of a laparoscope - in principle a light-conducting glass rod with a camera attached - now allows direct insights into the inside of a person without having to accept the disadvantages of a major operation. A whole series of surgical interventions can now be carried out using the laparoscopy, which previously required a large abdominal incision.

What happens during this procedure?

First, access to the inner abdominal cavity must be established. For this purpose, a thick special needle is pierced through the abdominal wall. As a rule, the lower navel pit is chosen as the puncture site, as this is where the distance between the skin and the brook cover is the smallest. This also has cosmetic advantages, as the remaining scar can hardly be seen at this point later.

Before the puncture, it is ensured that no large vessels or organs are in the way and could be injured. Only then will the doctor insert the puncture needle.

Even after the successful puncture, the surgeon still has to be patient with his insight. First of all, the abdomen has to be “pumped up” a little so that the tightly packed organs and intestinal loops do not block the doctor's view. For this purpose, an aseptic (sterile) tube is attached to the cannula lying on it and connected to a gas pump (insufflator). Then, with constant pressure measurement, carbon dioxide (CO2) is directed into the abdomen. Since the pressure in the abdomen is controlled all the time, nobody needs to be afraid of "bursting". Depending on the body size, the abdominal cavity is filled with 2.5 to 7 liters of gas until a kind of dome is formed and the surgeon can safely move between the organs with his instruments.

The puncture cannula (hollow needle) with its small diameter is not yet sufficient for the procedure as such. It is replaced by a plastic or metal sleeve (trocar) with a diameter of 5 to 12 mm. This is provided with a pointed end for piercing the abdominal wall, which is then pulled out again so that a kind of sleeve remains as an access. A valve ensures that the gas that has been introduced does not flow out again. Any gas that has disappeared is replaced again and again during the procedure.

Only now is the laparoscope inserted. First, the surgeon gets the necessary orientation through a panoramic view of the entire abdominal cavity. Not only the pelvic organs are assessed, but also the upper abdominal organs such as the stomach, liver and spleen. It is not uncommon for abnormal findings in organs to be discovered in this way for which the gynecologist is actually not primarily responsible.

One or two small incisions are made to insert additional instruments for each operation. As part of an outpatient laparoscopy, these instruments can be used to perform various operations on the pelvic organs. These include, for example:

  • the removal of benign uterine nodes (fibroids)
  • the removal of benign fluid-filled hollow bodies (cysts) on the ovaries
  • the cutting of the fallopian tubes
  • the removal of islets of the uterine lining in the abdomen (endometriosis)
  • the removal of a fallopian tube or ectopic pregnancy in which the fertilized egg has implanted in the fallopian tube instead of the uterus

When does the doctor advise you to have this procedure?

The doctor will recommend a surgical laparoscopy if benign ulcers such as uterine nodes (fibroids) or cysts on the ovaries cause discomfort and are small enough to be removed with a laparoscopy. In the case of endometriosis (displacement of uterine mucous membrane islands in the abdomen), the procedure serves both for diagnostic clarification and to remove the mucous membrane islands and thus for therapy. If an ectopic pregnancy is detected early, a laparoscopy is also necessary to remove the fertilized egg that cannot survive in the fallopian tube.

Sterilization is also carried out as part of a laparoscopy (reference: sterilization of the woman).

Which stunning method is usually used?

The surgical laparoscopy (laparoscopy) is usually performed under a brief general anesthetic (reference: general anesthesia). For you this means: apart from the induction of anesthesia, you will not notice anything, neither how your abdominal wall is pierced nor how your stomach is “pumped up”. You won't wake up until all instruments are removed and the procedure is over.

How long does the procedure take on average?

The duration of the procedure depends on the type of operation.

Who may not be suitable for this procedure?

A surgical laparoscopy can be technically difficult or even impossible in very overweight people. Even with many previous operations in the abdominal area, one would rather advise against a surgical laparoscopy, as adhesions in the abdomen can hinder access.

The operation may not be carried out if there is a suspicion of malignant diseases or in the case of certain previous internal diseases with impaired cardiopulmonary function. These include, for example, diseases of the coronary arteries (coronary artery disease, angina pectoris and chronic obstructive pulmonary disease (COPD)).

Infections in the abdominal cavity such as peritonitis and blood clotting disorders (coagulopathies with an increased tendency to bleed, e.g. Markumar® therapy) can also speak against a laparoscopy. It may also be advised against in the case of umbilical or incisional hernias or gaps in the diaphragm (hiatal hernia), as there is a risk that abdominal organs will be trapped in the gaps due to the increased pressure.

Ultimately, the decision rests with your treating doctor, who will assess your individual risks after the preliminary examinations.

How is the risk to be assessed?

The surgical laparoscopy (laparoscopy) is a very safe procedure with today's technology. Nevertheless, as with any surgical procedure, complications cannot be completely ruled out. In the vast majority of cases, however, they are manageable, even if a second intervention may be necessary in individual cases.

Your doctor will explain the type and frequency of complications such as bleeding, organ and vascular injuries or wound infections before the procedure.

What do you have to consider before the procedure?

From 10:00 p.m. on the evening before the procedure, you should stay sober, i.e. do not eat or drink, do not smoke or chew gum. If you take medication regularly because of other illnesses, you should inform your doctor or anesthetist in advance, as some medications such as blood-thinning substances should be discontinued a few days before the procedure. Since the abdomen may still be a little bloated after the procedure, you should wear clothes that are as loose as possible for the appointment.

What happens after the procedure and what should be considered?

Even with the surgical laparoscopy performed on an outpatient basis, you will remain under observation for a few hours after the procedure - until you feel fit for the way home. The anesthesia will subside relatively quickly, so that you will soon be available again. However, it may take a little longer before you are completely clear in your head again. You are therefore not allowed to drive your own car on the day of the procedure and you should also not use public transport on your own. Let family or friends pick you up or take a taxi home. You may be exhausted and sleepy for several hours after the procedure. So lie down in bed and rest. However, you should take a few steps on the day of the operation to get your circulation going again.

Due to the anesthesia, some patients may experience slight nausea after the operation, but this will soon subside.
Greater pain is not to be expected after a diagnostic laparoscopy. Some patients complain of right shoulder pain. The cause is suspected to be nerve irritation, which is caused by the increased pressure in the abdomen as the liver shifts. Some movement or positioning in bed with a pillow under your buttocks can help - if not, a mild pain reliever will help.

Don't be frightened if there are several larger plasters on your stomach - the wounds underneath are much smaller. As a rule, you can shower after 1-2 days, without lathering the wound and patting it dry. You should only treat yourself to a full bath after about 5 weeks.

You should avoid physical strain for a period of 5-6 weeks after a laparoscopy surgery.

When does the next doctor's appointment usually take place?

Before you leave the practice on the day of the procedure, your doctor will give you an appointment for the next check-up. In your own interest, you should definitely keep this appointment.

If you get a fever or severe pain at home, or if you notice reddening or other signs of inflammation on the wound, you should contact your doctor immediately. Even if you are unsure and still have questions about the normal course of healing, in practice no one will be angry with you if you call for advice.