The gas, the shoulder pain, the scars, the possibility of switching to open surgery partway through: what is not always said beforehand, and the questions worth asking before you say yes.
If a finding has been made on your imaging — a cyst, a fibroid, a lesion to be analysed — and keyhole surgery has been proposed, Dr Zeitoun sees patients in consultation to discuss whether to operate, which technique to use and what the pathway looks like. Second opinions are welcome. Consultations can be held in English.
Laparoscopy — often called keyhole surgery — is a way of operating inside the abdomen without opening it widely. The surgeon works through very small cuts: one at the navel, through which a camera a few millimetres across is passed, and one to three others, 5 to 12 mm, for the instruments. The camera image is shown greatly magnified on a screen, and that is what the team watches throughout the operation.
The operation itself does not change. Removing an ovarian cyst, removing a fibroid, removing the uterus, taking a sample of an abnormality so that it can be analysed: it is the same operation, decided on the same grounds, whether the surgeon works through small cuts or through an open abdomen. What changes is the recovery.
This article follows the pathway in order: why this route is chosen, what is checked beforehand, how the operation is carried out, what the first hours feel like — the swollen abdomen, the well-known shoulder pain —, the recovery, the risks, and what happens if the surgeon has to open the abdomen after all. Every figure quoted carries its source.
Whether to operate, which technique, what the following days look like, and a second opinion if you would like one: a consultation directly with the surgeon, at the practice or by video.
To see and to work, the surgeon needs space between the abdominal wall and the organs. The whole technique comes down to how that space is created, and then given back.
Carbon dioxide is introduced into the abdomen: the wall lifts, like a small tent above the uterus and the ovaries. It is this gas, more than the operation itself, that explains part of what you will feel in the following days — the tight abdomen, the shoulder pain.
One cut at the navel for the camera, one to three others of 5 to 12 mm for the instruments. Everything is done watching the screen, where the image is greatly magnified — considerably more than the eye would see through an open abdomen.
Where the anatomy allows it, keyhole surgery is now the first choice across much of gynaecological surgery. French national guidance — from the National College of French Gynaecologists and Obstetricians, on hysterectomy for benign disease and on heavy menstrual bleeding — places small-incision techniques ahead of open surgery whenever the anatomy permits.
In 2023, researchers brought together 63 studies in which women having a hysterectomy for benign disease had been allocated to one of the two techniques: small incisions on one side, an open abdomen on the other. Pooling those results gives four differences — two in favour of small incisions, two against.
These are averages, calculated across thousands of women. They compare two techniques with one another; they do not predict your own recovery, which will depend on the operation performed, on your anatomy, your history and your work. The full reference for this analysis is at the foot of the page.
It is used both to look and to operate. The commonest situations in a gynaecological surgery consultation:
The decision to operate is made on a file, not on a single symptom. Before an operation is booked, the imaging is reviewed — pelvic ultrasound, MRI where relevant —, along with previous operation notes and any pathology results. What is arranged before an operation is set out on the preparing for surgery page.
This is why it is worth bringing every scan you already have, including the older ones: comparing two images taken a few months apart is often what tells you the most.
If this is your first visit, the preparing for your first consultation page sets out what to bring. A separate anaesthetic consultation takes place before any operation. That is when to mention your medication, your allergies, your previous operations and any difficulty you have had with an anaesthetic in the past.
Consultations can be held in English, and a video consultation is possible for an opinion or a second opinion. Written reports are issued in French. As for everyone, an opinion is given on documents, in consultation — never by email.
Laparoscopy is carried out under general anaesthetic. Once you are asleep, the team lays out the sterile drapes, then the surgeon makes the small cut at the navel and passes the camera through it. If you have had abdominal surgery before, another entry point may be chosen: that is a question of adhesions, and it is planned in advance, not decided at the last moment.
The gas is introduced to create the working space. The other small cuts are then made while watching the screen — the surgeon can see exactly where each one passes. The operation is then carried out.
At the end, anything removed is brought out in a sealed retrieval bag when it is tissue that has to be analysed, so that nothing is spread inside the abdomen. The gas is let out as far as possible and the cuts are closed.
The tissue removed goes to the pathology laboratory. That analysis, and only that analysis, establishes exactly what the lesion was. It takes time, and the result is explained to you in consultation.
Seeking a second opinion before gynaecological surgery is common. Come, or connect, with the whole file: imaging, operation notes, pathology results.
Three sensations come up almost every time, and they are easier to live with when you have been told about them in advance.
Some gas always remains after the operation. The body absorbs it gradually. Until then the abdomen feels tight, sometimes tighter than it did before the operation — and that is entirely expected.
The gas that remains presses up under the ribs. At that spot, the nerves are the same as those of the shoulder: the brain misplaces the pain and puts it up there. It has nothing to do with your shoulder, and it goes as the gas does.
It comes mainly from the general anaesthetic and is managed. Pain from the cuts themselves is usually moderate: they are small. You may have very little wound pain and a great deal of abdominal discomfort from the gas — they are two separate things.
How long you stay depends entirely on the operation performed. Some laparoscopies are done as day cases; others need one or more nights. You are told what is planned before the operation, and it is reviewed afterwards according to how you are: it is never a figure fixed in advance on paper.
The way the days after surgery are handled has changed. A woman is no longer left without food, or in bed, any longer than necessary: she is got up early and fed early. Walking reduces the risk of clots and helps the bowel restart.
No operation is without risk. The patient information sheet on laparoscopy published by the National College of French Gynaecologists and Obstetricians lists, alongside the usual after-effects of abdominal and back pain and nausea from the anaesthetic:
Injury to the ureter deserves to be named separately: it is the one complication that the comparison of the two techniques quoted above finds slightly more frequent with small incisions than with an open abdomen, in hysterectomies.
A laparoscopy that has already begun sometimes has to be turned into an open operation. The reasons are always the same: adhesions that prevent a clear view, anatomy different from what the imaging suggested, a lesion larger than expected, bleeding that needs controlling.
It is not a failure, and it is not an accident: it is a decision taken in order to operate safely. It appears in the information document you sign before the operation, precisely because it is possible.
Goes through the wall of the abdomen and shows the outside of the uterus, the ovaries, the tubes and the peritoneum.
Goes through the natural passage and shows the inside of the uterine cavity. No cut at all. It is used for polyps, for some fibroids bulging into the cavity, and for taking samples of the lining. See the dedicated article.
Still a laparoscopy: the same small cuts, the same gas. What changes is the interface between the surgeon’s hand and the instruments.
👉 The same patient may be offered the first two during a single visit to theatre — for instance a diagnostic hysteroscopy followed by an operative laparoscopy.
A surgical consultation is not the delivery of a verdict. Here is what it is reasonable to ask, and what you should leave with a clear answer to.
Pelvic pain, heavy periods, a feeling of pressure: these symptoms go first to the general practitioner, the midwife or the gynaecologist. It is the assessment they arrange — and the finding it brings to light: a cyst, a fibroid, an ovarian abnormality, a pelvic mass, a lesion to be analysed — that then leads to a surgeon’s opinion.
The questions that come up most often in consultation. If yours is not here, do ask it at your appointment — or ask Sophie, the site’s assistant, at the bottom right.
Pain from the small cuts is usually moderate. What surprises most women is the discomfort from the gas: a tight abdomen, bloating, shoulder pain. Painkillers are prescribed and adjusted, and the recovery period is explained before you leave. Pain that increases rather than settles, or that comes with a fever, is not a normal after-effect: report it without waiting.
Because the gas that remains presses up under the ribs, and at that spot the nerves are the same as those of the shoulder. The brain misplaces the pain. It is harmless and it settles as the gas is absorbed. Walking helps.
Yes, but small ones: one at the navel, where it hides in the natural fold, and one to three others of 5 to 12 mm. They remain visible and fade over time — keeping an eye on them is part of the recovery period. This is not scarless surgery, and nobody can promise you in advance how a scar will finally look, since that also depends on your skin.
The abdomen is opened. This possibility is planned for and explained before the operation, and it forms part of what you consent to. The commonest reasons are adhesions, unexpected anatomy or bleeding that needs controlling. The operations concerned are set out on the benign gynaecological surgery page. Operating safely comes first.
Yes. Asking for a second opinion before gynaecological surgery is common and implies no discourtesy towards the first doctor. It helps to come, or to connect, with the whole file: imaging, operation notes, pathology results. Dr Zeitoun’s training and career are set out on the site. A surgical opinion is given on documents, not on a recollection of a consultation.
The Cochrane review of 29 August 2023 (Pickett CM et al., 63 pooled studies, hysterectomy for benign disease) puts the return to usual activities at 22 to 25 days after laparoscopy, against 37 days after open surgery. These are averages: the procedure performed, your job and your tiredness count as much as the route. The recovery period and how to prepare for surgery are set out on the site.
It depends on what has to be removed, its size, your previous abdominal surgery and what the imaging shows. Laparoscopy is the preferred route in benign gynaecological surgery and for many early-stage gynaecological cancers. The choice is discussed in consultation, on your documents, and the possibility of conversion is explained beforehand.
This is not fixed in advance: it is decided at the post-operative check, according to the procedure performed and to how you feel. The simple rule is pain — you do not resume something that hurts. Driving assumes you can brake hard without hesitating. The markers are detailed in the recovery period.
It depends on the procedure, the time of the operation and your situation at home. Some laparoscopies are done as day surgery, others warrant a night of monitoring. The decision is made with the surgeon and the anaesthetist at the anaesthetic consultation: see preparing for surgery.
Pain that increases instead of easing, fever, vomiting that will not settle, a hard abdomen, a red or leaking wound, breathlessness, pain in one calf: none of these waits for the scheduled appointment. Call the secretariat or the clinic, at the slightest doubt. The after-effects that are normal are described in the recovery period.
Yes, in most cases. Ovarian cyst surgery, myomectomy for fibroids, surgery of the ovaries and tubes and hysterectomy are all routinely done this way. The size of the lesion, its presumed nature and your history guide the decision. For the uterus, see also benign uterine surgery and hysteroscopy, which goes through the natural passages and is not a laparoscopy.
The indication is set in consultation, on your imaging and your reports — not on an isolated symptom. Dr Jérémie Zeitoun consults in Paris 8 and operates at Clinique Hartmann in Neuilly-sur-Seine; his training and career is set out on the site. An abnormality found on ultrasound or MRI — a cyst, a fibroid, a pelvic mass — is the usual reason for a surgical opinion. A second opinion is possible, in person or by video consultation before travelling: book an appointment or request a callback.
To go further into the operations performed by this route and the findings that lead to them.
The four areas covered — uterus, ovaries and tubes, cervix, vulva and vagina — and the operations that go with them.
Patient articleEndometrioma, dermoid cyst, functional cyst: what is watched, what is operated on, and the grounds the decision rests on.
OperationRoutes (laparoscopy, vaginal, open), what follows the operation, recovery — everything worth knowing beforehand.
If a finding has been made on your imaging, if keyhole surgery has been proposed, or if you would like a second opinion before deciding, Dr Jérémie Zeitoun sees patients at the practice in the 8th arrondissement of Paris and at the Clinique Hartmann in Neuilly-sur-Seine, as well as by video consultation. The “Request a callback” form is also the way to send a report through, or to say so if none of the slots offered suits you.