Laparoscopy, often called keyhole surgery, lets a gynecologist operate inside the abdomen through three or four small cuts instead of one long incision. A thin telescope with a camera is passed in near the navel, the pelvic organs are seen magnified on a screen, and fine instruments do the work through the other small openings. For most women this means less pain, a shorter stay in hospital, smaller scars and an earlier return to home and work than open surgery.
Keyhole surgery is now the usual route for many common gynecological operations: removing ovarian cysts, fibroids and endometriosis, treating an ectopic pregnancy, checking the fallopian tubes in infertility, and removing the uterus when that is needed. Its close cousin, hysteroscopy, goes one step further and reaches the inside of the uterus through the cervix with no cut on the abdomen at all.
Dr. Devang Patel, M.D. (Obstetrics & Gynecology, Gold Medalist), is a laparoscopic surgeon with more than 3,000 surgeries performed, and operates at Divine Women’s Hospital, Gota, an NABH-accredited hospital. This page explains what laparoscopy involves, how to prepare and what recovery looks like. The pages on hysterectomy, ovarian cysts and fibroids go into each operation in detail.
What happens during a laparoscopy
The operation is done under general anaesthesia, so you are fully asleep. A small cut is made in or just below the navel and the abdomen is gently filled with carbon dioxide gas. The gas lifts the abdominal wall away from the organs and creates space to see and work safely.
The laparoscope, a telescope about 5 to 10 mm wide, is passed through that opening and connected to a camera. Two or three more small cuts lower down allow instruments to grasp, cut, seal blood vessels and stitch. At the end the gas is let out, the cuts are closed with small stitches or skin glue, and you wake up in the recovery area.
A diagnostic laparoscopy, simply to look and take samples, may take 20 to 30 minutes. A cyst removal often takes about an hour, while a myomectomy or hysterectomy can take two hours or more, depending on size and on any scarring from previous surgery.
Conditions treated by keyhole surgery
- Ovarian cysts, including dermoid cysts and endometriomas, removed while preserving healthy ovarian tissue
- Fibroids in the wall of the uterus (laparoscopic myomectomy), keeping the uterus for future pregnancy
- Endometriosis, by excising or treating the deposits and releasing adhesions that cause pain
- Ectopic pregnancy, by removing the pregnancy and, where suitable, conserving the tube
- Ovarian torsion, as an emergency, to untwist and save the ovary whenever possible
- Infertility work-up, with a dye test to check whether the fallopian tubes are open
- Hysterectomy, removal of the uterus when childbearing is complete and other treatments have not helped
- Permanent sterilisation (tubal ligation) for women who are sure their family is complete
- Hysteroscopic procedures inside the uterus: polyps, submucosal fibroids, a uterine septum and adhesions
Keyhole, open or hysteroscopic: how they compare
The right route depends on what needs to be done and on your own health. The comparison below is a general guide; your plan is based on your scans and examination.
| Approach | How it is done | Typical stay and recovery | Commonly used for |
|---|---|---|---|
| Laparoscopy | 3–4 small cuts on the abdomen, camera and gas | 1–2 days in hospital; desk work in 1–2 weeks | Cysts, endometriosis, myomectomy, ectopic pregnancy, hysterectomy |
| Hysteroscopy | Camera passed through the cervix into the uterus; no abdominal cut | Often same-day discharge; normal activity in 1–2 days | Polyps, cavity fibroids, septum, adhesions, abnormal bleeding |
| Open surgery (laparotomy) | One larger cut, usually a bikini-line incision | 3–5 days in hospital; recovery over 6–8 weeks | Very large fibroids or uterus, dense adhesions, suspected cancer |
| Vaginal surgery | Operation done through the vagina, no abdominal cut | 1–3 days; recovery over 4–6 weeks | Selected hysterectomies, prolapse repair |
Who is suitable, and when open surgery is wiser
Most women can have gynecological surgery by laparoscopy. Previous caesarean sections are common in India and are not a barrier, although scar tissue can make the operation longer and needs careful entry into the abdomen.
Open surgery may be the better choice for a very large uterus or fibroid, for extensive scarring from several earlier operations, for some heart or lung conditions in which the gas and head-down position are poorly tolerated, and when a cancer is suspected and a specialist oncology operation is needed. In a small number of keyhole operations, typically a few in every hundred, the surgeon converts to an open incision during surgery because of bleeding, adhesions or difficult anatomy. This is a safety decision, not a failure, and it is discussed with you beforehand.
Getting ready for surgery
Good preparation reduces complications and speeds recovery. Most of it happens in the week or two before admission.
- Blood tests: haemoglobin, blood group, sugar, kidney function, thyroid where relevant, and screening for hepatitis B, hepatitis C and HIV
- An ECG and anaesthetic check, with a chest X-ray or other tests if your age or health calls for them
- Correction of anaemia first: haemoglobin below about 10 g/dL is common with heavy periods and is treated with iron tablets or an iron infusion before planned surgery
- Review of medicines: blood thinners, some diabetes tablets and herbal or ayurvedic preparations may need to be paused
- Fasting: usually no food for 6 hours before surgery, with clear fluids such as water allowed until 2 hours before, as instructed
- Planning around your cycle, and a pregnancy test on the day of surgery for women who could be pregnant
- A clear consent discussion covering the aim of surgery, the alternatives, the risks and what may be removed if unexpected findings arise
Risks, and how they are kept low
Laparoscopy is a common and generally safe operation, but no surgery is free of risk. For diagnostic laparoscopy, the Royal College of Obstetricians and Gynaecologists quotes an overall risk of a serious complication of about 2 in every 1,000 women. More complex operations carry a higher risk, which is discussed individually.
- Shoulder-tip pain and bloating from the gas: very common, harmless and usually gone in 1–3 days
- Wound infection or bruising at the small cuts, managed with dressings and sometimes antibiotics
- Bleeding, rarely enough to need a blood transfusion or a return to theatre
- Injury to the bowel, bladder, ureter or major blood vessels: uncommon, and reduced by careful entry technique and by recognising and repairing it at the time
- Blood clots in the legs or lungs, reduced by early walking, fluids, compression stockings and, for higher-risk women, blood-thinning injections
- Hernia at a cut site, uncommon, reduced by closing larger port sites in layers
Most problems after keyhole surgery show themselves within the first few days, so knowing the warning signs and having a number to call matters as much as the operation itself.
Recovery at home
Most women are encouraged to sip fluids and walk within a few hours of waking. After a cyst removal or diagnostic laparoscopy many go home the next day; after a myomectomy or hysterectomy a stay of one to two days is usual. A hysteroscopy is often a day-care procedure.
Expect some tiredness for a week or two. Simple pain relief such as paracetamol is usually enough after the first day or two. Showering is fine after 24–48 hours; keep the cuts clean and dry, and avoid soaking in a bath until they have healed.
- Walking and light household work: from the first few days
- Desk work: often 1–2 weeks after a cyst or diagnostic procedure; 2–4 weeks after myomectomy or hysterectomy
- Driving: once you can brake hard without pain and turn comfortably, often 1–2 weeks
- Lifting heavy objects, gym and strenuous exercise: usually after 4–6 weeks
- Intercourse: after 2 weeks for most procedures, and about 6 weeks after hysterectomy, when the vaginal vault has healed
Keyhole surgery, fertility and future pregnancy
Because the tissues are handled gently and exposed to the air for less time, laparoscopy tends to cause fewer internal adhesions than open surgery. That matters for women who still hope to conceive, since adhesions around the tubes and ovaries can affect fertility.
After removing a cyst, the aim is always to keep as much healthy ovary as possible. After a laparoscopic myomectomy, a gap of about three to six months is usually advised before trying to conceive, so the uterine wall can heal, and a caesarean birth may be recommended if the fibroid was deep. After an ectopic pregnancy treated by keyhole surgery, many women conceive again, and an early scan in the next pregnancy confirms that it is in the right place.
How keyhole surgery is organised at Divine Women’s Hospital
Dr. Devang Patel assesses you in the clinic, reviews or repeats the scans, and explains whether surgery is needed at all before any date is planned. When it is, you receive a written plan covering the procedure, the expected stay and the recovery time, so that work and family arrangements can be made in advance.
Surgery takes place at Divine Women’s Hospital, Gota, an NABH-accredited hospital with round-the-clock emergency care, so emergencies such as a twisted ovary or a ruptured ectopic pregnancy can be operated on at any hour. Consultations are held in Gujarati, Hindi or English, and the findings, photographs from surgery where taken, and the tissue report are gone through at the follow-up visit.
Your care, step by step
- Consultation and scansYour symptoms, previous surgery and plans for pregnancy are discussed, and the ultrasound or MRI is reviewed to decide whether surgery is needed.
- Pre-operative checkBlood tests, anaesthetic review and correction of anaemia, with clear written instructions on medicines and fasting.
- SurgeryThe keyhole operation is done under general anaesthesia, with you walking and drinking within hours.
- Going homeUsually after one or two days, with pain relief, wound advice and a direct number to call with concerns.
- Follow-upA review at about one to two weeks to check healing and go through the operative findings and tissue report.
When to book a visit
- An ovarian cyst or fibroid has been found on a scan and you want to know whether it needs surgery
- Periods are heavy or painful enough to disturb work, school or sleep
- Pelvic pain, pain during intercourse or painful bowel movements that suggest endometriosis
- You have been trying to conceive for a year (six months if over 35) and your tubes have not been checked
- You have been advised a hysterectomy and want to understand the options
- You would like a second opinion before a planned operation
Warning signs - get same-day care
- Sudden, severe one-sided lower abdominal pain with vomiting, which may mean a twisted ovary
- Abdominal pain, fainting or shoulder-tip pain with a positive pregnancy test or a missed period, which may mean an ectopic pregnancy
- After surgery: fever above 38 °C, or pain that is getting worse rather than better after the second day
- After surgery: persistent vomiting, a swollen tight abdomen or inability to pass wind
- After surgery: calf swelling, chest pain or sudden breathlessness
- After surgery: heavy vaginal bleeding, or a wound that is red, hot or discharging pus
Labour and emergency care are available 24 × 7. Call the hospital and come in directly.
Myths and facts
Myth: Keyhole surgery is minor surgery.
The cuts are small, but the operation inside can be just as extensive as open surgery. It needs the same preparation, anaesthesia and respect for recovery.
Myth: You must stay in bed for weeks after a laparoscopy.
Early walking lowers the risk of clots and speeds recovery. Most women walk within hours and are back to light activity within days.
Myth: Anyone with a previous caesarean cannot have laparoscopy.
Women with one or more caesareans routinely have keyhole surgery. Scar tissue is anticipated and the entry into the abdomen is planned accordingly.
Myth: If the surgeon switches to an open operation, something has gone wrong.
Converting to open surgery is a planned safety option used when it is the safer way to finish the operation. It is discussed in the consent conversation.
Frequently asked questions
How long does a laparoscopy take?
A diagnostic laparoscopy may take 20 to 30 minutes and a cyst removal around an hour. A myomectomy or hysterectomy usually takes two hours or more. You will also spend time in the recovery area before returning to your room.
How many days of hospital stay are needed after laparoscopic surgery?
Most women go home after one or two days. Very short procedures may allow discharge the same evening, while a large myomectomy or a woman with other medical conditions may need slightly longer.
Why do I have shoulder pain after laparoscopy?
The carbon dioxide gas used to create space can irritate the diaphragm, and the pain is felt in the shoulder. It is very common, harmless and settles within one to three days. Walking, warm drinks and simple pain relief help.
Will there be scars after keyhole surgery?
There will be small scars, usually one at the navel and two or three lower down, each 5 to 10 mm. They fade over months and are usually much less noticeable than an open incision, but they do not disappear completely.
Is laparoscopy done under general or spinal anaesthesia?
Gynecological laparoscopy is almost always done under general anaesthesia, because the abdomen is filled with gas and the table is tilted. Hysteroscopy can sometimes be done with spinal or short general anaesthesia, or in the clinic for small procedures.
When can I go back to work after laparoscopy?
After a diagnostic laparoscopy or cyst removal, desk work is often possible within one to two weeks. After a myomectomy or hysterectomy, two to four weeks is more usual. Physically demanding jobs need about four to six weeks.
Can laparoscopy be done during periods?
Planned surgery is usually timed for after the period, which makes the operation easier and allows a pregnancy test to be meaningful. Emergency surgery, such as for torsion or ectopic pregnancy, is done whenever it is needed.
Is laparoscopy safe after two caesarean sections?
Yes, for most women. Previous caesareans increase the chance of adhesions, so the first entry is made carefully, sometimes away from the old scar. Your previous operation notes, if available, are helpful to bring.
What should I eat after laparoscopic surgery?
Start with fluids such as water, coconut water and buttermilk, then light food such as khichdi, dal-rice, soup and fruit over the first day. Plenty of fluids and fibre help avoid constipation, which can make abdominal discomfort worse.