What is laparoscopy?
Laparoscopy (also known as keyhole or minimally invasive) surgery allows a surgeon to perform operation inside the abdomen (tummy) and pelvis without having to make large incisions on the skin.
How is it performed?
Once patient is asleep with general anaesthetic antiseptic preparations are made. A small needle is then passed through umbilicus (belly button) and carbon dioxide gas is pumped to inflate the abdomen (tummy). Inflation of abdomen reduces the risk of injury and allows the surgeon a better visual field and space to perform procedures. slightly larger (5-10mm) trocars (tubes) are then inserted through small holes in abdominal wall, one of which is used to for the laparoscope and others for the laparoscopic instrument that performs the planned procedure. Laparoscope is attached with the light sources and relays the pictures to a television screen. Several highly specialised laparoscopic instruments are available to carry out specific jobs during the operation.
After the planned procedure is completed, surgeon will ensure that there is no bleeding and will let out the carbon dioxide. All small incisions are closed using dissolvable stitches. Patient is then awaken.How long does it take?
Depending on the indication it could take 30min (simple diagnostic laparoscopy) to upto 5 hours for complex cancer operation (e.g. trachelectomy)What are the advantages?
What are the disadvantages?
- Shorter hospital stay and recovery time
- Less pain, bleeding and infection risk
- Cosmetically much less scarring
There are no real disadvantages of laparoscopic surgery compared to open surgery however…
What are the risks and complications?
- Not all gynaecological operations can be done laparoscopically. For example large tumours involving ovaries or uterus usually requires incision.
- Also laparoscopic surgery requires a complex set of skills which are acquired by specific training, special interest and continued exposure of complex laparoscopic procedures. Compared to open surgery laparoscopic surgery requires additional skills to accommodate 3D orientation, understanding of tactile sensation through instrument, ergonomics of laparoscopy and energy used through instrument and above all additional safety precautions specific to laparoscopic procedures.
Laparoscopy in gynaecology is a commonly performed procedure and serious complications are rare.
Minor complications include:
- Wound infection
- Minor bleeding or bruising around the incision
- Feeling or being sick
Serious complications include:
Which gynaecological procedures are performed with laparoscopy?
- Damage to an internal organ nearby such as bowel, bladder or ureters (urine tubes) during the operation
- Clots in leg or lung
- Heavy bleeding during operation
- Ovarian operations such as ovarian cyst/tumour removal, treatment of PCOS, oophorectomy for tumour or cancer risk reduction
- Fallopian tube procedures such as clip ligation (permanent contraception), removal of tube (ectopic pregnancy and cancer risk reduction)
- Uterine operations such as myomectomy (removal of fibroid) and hysterectomy
- Complex cancer operations such as radical hysterectomy, trachelectomy and lymph node excision
- Investigations and treatment of infertility, endometriosis and pelvic pain