Gynecologic Laparoscopy in Pokhara: Treatment for Fibroids, Cysts & Endometriosis
Gynecologic laparoscopy — often called keyhole surgery — has transformed women’s gynecologic treatment over the past two decades. Conditions that once required a large abdominal incision and weeks of recovery can now be treated through two or three incisions the size of a fingernail, with most patients going home within 24–48 hours.
In Nepal, access to laparoscopic gynecologic surgery has historically been limited to Kathmandu. A&B International Hospital in Pokhara now provides this capability locally, allowing women from across the Gandaki Province to receive minimally invasive gynecologic surgery without traveling to the capital.
What Is Gynecologic Laparoscopy?
Gynecologic laparoscopy is a minimally invasive surgical technique in which a thin, lighted camera (laparoscope) is inserted through a small incision near the navel, along with surgical instruments through additional small incisions, to diagnose and treat conditions inside the pelvic cavity.
The abdomen is inflated with carbon dioxide gas to create space for the surgeon to see and work. The laparoscope transmits a magnified image to a monitor, and the surgeon operates using precision instruments guided by this view. The result is a procedure that achieves the same surgical goals as open surgery — removing a cyst, excising endometriosis, repairing a tube — but through incisions of 5–10 mm rather than 10–15 cm.
Gynecologic laparoscopy serves both diagnostic and therapeutic purposes. A diagnostic laparoscopy can confirm endometriosis, assess the fallopian tubes for blockage, or investigate unexplained pelvic pain when other tests are inconclusive. A therapeutic laparoscopy treats the condition during the same procedure.
What Gynecologic Conditions Are Treated with Laparoscopy at A&B?
A&B International Hospital uses laparoscopic techniques for the full range of benign gynecologic conditions amenable to minimally invasive surgery.
Ovarian cysts (laparoscopic cystectomy): Ovarian cysts that are large, causing symptoms (pain, pressure), or showing features suspicious for malignancy are removed laparoscopically. The cyst is excised while preserving the remaining healthy ovarian tissue — important for women who wish to maintain fertility. Dermoid cysts, endometriomas (chocolate cysts), and simple functional cysts that have not resolved on observation are typical candidates.
Uterine fibroids (laparoscopic myomectomy): Fibroids on the outer surface of the uterus (subserosal) and some within the uterine wall (intramural) can be removed laparoscopically, preserving the uterus for women who want future pregnancies. Fibroids inside the uterine cavity (submucosal) are typically removed with hysteroscopy.
Endometriosis: Tissue resembling the uterine lining that grows outside the uterus — on the ovaries, fallopian tubes, bowel, and pelvic lining — is excised or ablated (destroyed by heat or laser) during laparoscopy. This is the definitive diagnostic and therapeutic procedure for endometriosis. Medical treatment with hormones suppresses endometriosis but does not excise it.
Ectopic pregnancy: A fertilized egg implanted in the fallopian tube (rather than the uterus) is a medical emergency. Laparoscopic salpingostomy (opening the tube and removing the pregnancy) or salpingectomy (removing the tube) is the definitive treatment, depending on tube condition and patient circumstances.
Tubal ligation: Permanent female sterilization by blocking or removing the fallopian tubes is performed laparoscopically as a daycare or overnight procedure. Women who have completed their family size and wish a permanent contraceptive method are candidates.
Diagnostic laparoscopy: For women with unexplained pelvic pain, infertility, or suspected endometriosis where non-invasive investigations have been inconclusive, direct visualization of the pelvic organs confirms the diagnosis and guides further management.
What Are the Advantages of Laparoscopic Surgery over Open Surgery?
Laparoscopic surgery offers measurable advantages over open (laparotomy) surgery for the same gynecologic conditions. These advantages are why minimally invasive surgery has become the preferred approach in modern gynecologic practice.
Smaller incisions and less pain: Three or four 5–10 mm incisions cause substantially less pain than a 10–15 cm laparotomy incision. Patients require less post-operative analgesia and are more comfortable during recovery.
Shorter hospital stay: Most laparoscopic gynecologic procedures require 1–2 days of hospital stay compared to 4–7 days after open surgery.
Faster return to normal activities: Patients return to light activity within 1–2 weeks after laparoscopy. Recovery from laparotomy requires 4–6 weeks of restricted activity.
Reduced risk of adhesion formation: Open surgery creates adhesions (internal scar tissue) that can cause future pelvic pain and fertility problems. The reduced tissue handling in laparoscopy lowers adhesion risk.
Better cosmetic outcome: Small laparoscopy incision marks fade significantly over time. A laparotomy scar on the abdomen is permanent.
Reduced blood loss: Laparoscopic surgery typically involves less blood loss than open surgery for the same procedure.
Lower infection risk: Smaller wounds are less susceptible to infection than long abdominal incisions, particularly relevant in Nepal’s humid climate.
How Is Gynecologic Laparoscopy Performed?
The procedure is performed in a sterile operating theater under general anesthesia. The typical sequence is:
- General anesthesia is administered
- Patient positioning — the operating table is tilted (Trendelenburg position) to move abdominal organs away from the pelvis
- CO2 insufflation — a Veress needle is inserted near the navel and carbon dioxide gas inflates the abdomen, creating the working space
- Laparoscope insertion — the camera is inserted through a 10 mm port at the navel
- Working ports — one or two additional 5 mm ports are placed in the lower abdomen for surgical instruments
- Procedure — the gynecologist performs the planned procedure under direct laparoscopic vision
- Closure — CO2 gas is released, ports are removed, and incisions are closed with sutures or surgical clips
Operative time varies: a diagnostic laparoscopy may take 20–30 minutes; laparoscopic myomectomy for large or multiple fibroids may take 1.5–2.5 hours.
What Is Recovery Like After Gynecologic Laparoscopy?
Recovery from laparoscopic gynecologic surgery is significantly shorter than from open surgery, with most patients returning to light daily activities within 5–7 days.
Immediate post-operative period (Hospital, Day 1–2):
- Nausea and shoulder tip pain (from CO2 gas irritating the diaphragm) are common on Day 1 — both resolve within 24–48 hours
- Mild abdominal bloating and cramping
- Regular analgesia (paracetamol, NSAIDs) — opioids rarely needed
- Mobilization begins on Day 1
At home (Week 1–2):
- Light activities permitted; avoid heavy lifting, strenuous exercise
- Showering is permitted after 48 hours; baths should wait until wounds are healed
- Some vaginal discharge is expected after procedures involving the uterus
- Wound check at 7 days
Return to work: Most office-based workers return to work within 5–7 days. Manual labor or physically demanding work requires 2–3 weeks.
Return to sexual activity: Typically after 2 weeks for simple laparoscopy; after 4–6 weeks if the uterus was opened (myomectomy).
Driving: Usually safe after 5–7 days when the patient is comfortable and not on opioids.
What Are the Risks of Gynecologic Laparoscopy?
Laparoscopy is generally safe, but like all surgery it carries defined risks that patients are informed of prior to consenting.
Risks specific to laparoscopy include:
- Port site hernia — rare; bowel can occasionally herniate through a laparoscopy incision if it is not closed correctly
- CO2-related shoulder pain — common, self-resolving
- Conversion to open surgery — if laparoscopic access is impossible due to dense adhesions, bleeding, or unexpected anatomy, the surgeon may convert to open surgery. This is not a complication — it is a safety decision.
General surgical risks:
- Bleeding requiring transfusion (low risk for laparoscopy)
- Wound infection
- Anesthetic risks (assessed pre-operatively)
- Bowel, bladder, or ureter injury — rare but important; A&B’s team discusses this during the consent process
Who Is a Candidate for Laparoscopic Surgery at A&B?
Most women with benign gynecologic conditions are candidates for laparoscopic surgery. Factors that may influence the approach include:
- Previous abdominal surgery: Dense adhesions from prior laparotomy may make laparoscopy technically difficult but are not an absolute contraindication
- BMI: Very high BMI increases laparoscopic technical difficulty and anesthetic risk
- Size of fibroids: Very large fibroids (>10 cm) may be better managed with open myomectomy
- Suspected malignancy: If cancer is suspected, open surgery may be preferred to allow full staging
The gynecology team at A&B assesses each patient individually and recommends the most appropriate surgical approach.
Book a Laparoscopic Gynecology Consultation in Pokhara
If you have been diagnosed with ovarian cysts, fibroids, endometriosis, or unexplained pelvic pain, and want to know if laparoscopic surgery is right for you — consult the A&B gynecology team in Pokhara.
A&B International Hospital
Pokhara-02, Bindhyaabasini
Phone: +977 061-412512
Website: abinthospital.com
Minimally invasive gynecologic surgery available in Pokhara. ECHS-eligible patients receive cashless treatment. Appointments available by call or walk-in.
