Laparoscopic Tubal Ligation :
Minimally Invasive Surgery
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Laparoscopic tubal ligation is one of several forms of sterilization. The operation is commonly called "tying the tubes." Inside your abdomen, two fallopian tubes connect each of your ovaries to your uterus. Once a month, an egg travels down one of the tubes and into the uterus, where fertilization and pregnancy can occur. The possibility of this can be completely eliminated simply by closing off the tubes which is what a tubal ligation accomplishes. In the laparoscopic type of tubal ligation, the doctor works with a long metal tube inserted into the abdomen through a tiny incision. This tube, or "laparoscope," has a tiny light and video camera at its tip. With its aid, the doctor ties, cuts, burns, or clips the tubes closed. Be certain you don't want any more children before you get a tubal ligation. Even though the operation can be reversed, there is no guarantee that you will be able to get pregnant again afterwards. Tubal ligation has no effect other than sterilization. You will continue to have monthly periods, and your sex drive will be unchanged.
There are always risks with surgery. You may bleed more than usual, develop an infection, have trouble breathing, or get blood clots. However, the doctor is prepared to deal with such problems.
If You're Heading For The Hospital...
Before You Go
The Week Before Surgery :
- You'll probably need to stop taking aspirin and ibuprofen; the doctor will tell you when. If you're taking aspirin for your heart, don't stop without asking the doctor first. Also ask whether you can take any over-the-counter medicines.
- Your doctor will tell you whether you need to have blood drawn.
The Night Before Surgery :
- Your physician may suggest you take a sleeping pill.
- Just before surgery, you should not eat or drink anything (even water). Your doctor will tell you when to begin fasting.
When You Arrive
- Check with your doctor before taking insulin, diabetes pills, blood pressure medicine, heart pills, or any other medication on the day of surgery.
- Do not wear contact lenses to the hospital. You may wear glasses.
What to Expect While You're There
You may encounter the following procedures and equipment during your stay.
Taking Vital Signs : These include your temperature, blood pressure, pulse (counting your heartbeats), and respirations (counting your breaths). A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm.
Blood Tests : You may need blood taken for tests. It can be drawn from a vein in your hand or from the bend in your elbow. Several samples may be needed.
Chest X-ray : This is a picture of your lungs and heart that will help the doctor during the procedure.
Heart Monitor : (Also called an electrocardiogram [e-LEK-tro-KAR-di-o-gram] or EKG). Three to five sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen or to a small portable box (telemetry unit) that shows a tracing of each heartbeat. Your heartbeat will be carefully monitored throughout the operation.
IV : A tube placed in your vein for giving medicine or liquids. It will be capped or have tubing connected to it.
Pulse Oximeter : To check the amount of oxygen in your blood, you may be hooked up to a pulse oximeter (ox-IM-uh-ter). It is placed on your ear, finger, or toe and connected to a machine that reads the level.
Anesthesia : This medicine will make you comfortable during surgery. Depending on the type of anesthesia, you may be awake during the operation, or completely asleep. You and your doctor will decide which approach is best for you. There are three possibilities:
Spinal Anesthesia : With this type of anesthesia, a pain-killing medication is injected into your spine. It will leave you awake during surgery, but numb below the waist. Feeling will return in about 2 hours.
Epidural Anesthesia : This approach requires insertion of a tiny tube into the spinal area. The tube is left in place so that you can be given additional pain-killing medication, if needed. As with spinal anesthesia, you will be awake during surgery, but numb below the waist.
General Anesthesia : This type of anesthesia puts you completely to sleep. It is given either as a liquid in your IV or as a gas through a face mask or endotracheal (END-o-TRA-kee-ull) tube placed in your mouth and throat.
The doctor will insert the laparoscope and other instruments through several small incisions in or below your belly button and at your pubic hair line. Carbon dioxide will be pumped into your abdomen to lift the abdominal wall away from the organs so the doctor can see them clearly. Using special remote-control tools, the doctor will tie and cut, burn, or clip the tubes closed. The incisions will be sewn closed with thread. The operation will be finished in 30 minutes to 1 hour.
You will be taken to the recovery room, where you'll remain until you either wake up or get the feeling back in the numbed area. A doctor may briefly remove your bandages soon after surgery to check the stitches. You'll then be taken back to your room or allowed to go home. As you begin your recovery, you'll be instructed in the following :
Deep Breathing and Coughing : These exercises help prevent a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum from your lungs and keep them clear. You should deep breathe and cough every hour while you are awake, including any time you spend awake during the night.
Hold a pillow tightly against your abdomen to help reduce pain from your incision. Take a deep breath and hold it as long as you can. Then push the air out of your lungs with a deep strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
Incentive Spirometer (spy-ROM-uh-tur) : This piece of equipment helps you take deeper breaths. Put the plastic nozzle into your mouth, take a very deep breath, and hold it as long as possible. Then blow as hard as you can into the mouthpiece. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
Activity : You may need to rest in bed until you are feeling better. Even in bed, however, you can still exercise by lifting one leg off the bed and drawing big circles with your toes, then repeating with the other leg. Another good exercise is to lie on your side and pretend to pedal a bike. Such exercises keep your legs strong and prevent blood clots from forming. Stop when you become tired. The doctor will tell you when it's OK to get out of bed. Call a nurse before getting up for the first time. Later, if you feel weak or dizzy upon standing, sit or lie down right away. Then call a nurse.
Eating : When your doctor can hear bowel sounds (stomach growling) through a stethoscope, you'll be able to eat. You will probably get ice chips first and then liquids (water, broth, apple juice, or soda). If you do not have problems with the liquids, you'll then be allowed to eat soft foods such as ice cream, applesauce, or custard. If these foods agree with you, you can return to a regular diet.
Bowel Movements : Regular bowel movements can be difficult after surgery. Don't strain if the stool is too hard. Walking will help to stimulate the bowels. Eating foods rich in fiber, such as fruit, bran cereal, and beans, will also help restore regularity. Drink plenty of liquids; prune juice may help make the stool softer. Or, if your doctor approves, you can take an over-the-counter fiber laxative.
Antibiotics : These medicines help prevent bacterial infection. They may be given by IV, as a shot, or by mouth.
Pain Medicine : To ease pain after the operation, your doctor will probably prescribe medication to be given by IV, as a shot, or by mouth. Tell the doctor or your nurses if the pain won't go away or comes back.
Anti-Nausea Medicine : This medicine calms your stomach and controls vomiting. Your doctor may suggest you take this medication at the same time as your pain medicine, which sometimes upsets the stomach.
Stool Softeners : These medications make bowel movements softer so you won't need to strain.
After You Leave
- For pain and swelling, you can use ice for the first 24 to 48 hours after the operation. Put the ice in a plastic bag, cover it with a towel, and place it over the incisions for 15 to 20 minutes out of every hour as long as needed. Do not sleep on the ice pack; it could cause frostbite.
- After the first 24 to 48 hours you may use heat to reduce pain and swelling. Heat brings blood to the area and helps it heal faster. Use a heating pad (turned on low) or a hot water bottle, or sit in a warm water bath for 15 to 20 minutes out of every hour as long as you need it. Do not sleep on the heating pad or hot water bottle; you could get a burn.
- You may feel dizzy or tired and have abdominal pain or a gassy, bloated feeling. These symptoms should disappear in 1 to 3 days. There may also be some vaginal bleeding for a day or two.
- You may also have neck or shoulder pain because of the gas used during surgery. Applying heat to your shoulder will ease the pain. Acetaminophen or ibuprofen will also help.
- When you are allowed to bathe or shower, carefully wash the stitches or staples with soap and water and then put on a clean, new bandage. You may change your bandage any time it gets wet or dirty.
- You'll need more rest after surgery. Increase your activity slowly and rest whenever you feel you need to. Start exercising slowly as soon as you feel stronger and do more as you get better. Exercising makes the heart stronger, lowers blood pressure, and keeps you healthy. Your doctor will tell you when it's safe to start lifting heavy objects.
- Eat healthy foods from all the 5 food groups fruits, vegetables, breads, dairy products, meat and fish. A balanced diet will make you feel better and have more energy. It also aids healing.
- Drink 6 to 8 large glasses of liquid each day. (If you are on a fluid limit, follow your doctor's advice.) You may take water, juices, and milk, but cut down on caffeinated beverages such as coffee, tea, and soda.
- Ask your doctor when you may resume having sex. If intercourse causes pain, stop.
- Always take your medicine as directed. If it doesn't seem to help, tell your doctor, but keep taking it until told otherwise. If you've been prescribed antibiotics, be sure to use them up even if you feel better. If a medicine makes you drowsy, avoid driving or using dangerous machinery.
Call Your Doctor If...
- Your incisions are swollen or red, or you see pus coming from them. This could mean they're infected.
- Your stitches come apart.
- Your bandage becomes soaked with blood.
- You develop heavy bleeding from the vagina.
- You have worsening abdominal pain.
- You have a high temperature.
Seek Care Immediately If...
- You suddenly have trouble breathing. You could have a blood clot in your lungs, or might be allergic to a medicine you're taking.
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