Laparoscopic Surgery

In gynaecology, common indications for performing laparoscopic surgery are:

• Endometriosis (diagnosis and treatment)
• Ovarian cysts (cystectomy is often performed laparoscopically)
• Fibroids (myomectomy)
• Ectopic pregnancy (diagnosis and treatment)
• Hysterectomy (may be performed for heavy periods, fibroids or endometrial cancer)
• Diagnosis and treatment of pelvic pain

Laparoscopic approach is now the default way of performing many standard operations including major procedures such as hysterectomy and myomectomy. Open surgery has now become relatively uncommon. In Mr Pisal’s surgical audit of 150 consecutive operations, only three were performed as open procedures.

Under general anaesthesia, a small 5mm incision is made inside the umbilicus and a needle is inserted to inflate the abdominal cavity with gas. This is necessary to provide adequate space to perform the procedure safely. A telescope (long tube with camera at one end) is then inserted inside the abdomen. The image is displayed on a television screen and all surgery is carried out under direct vision. This can be recorded in the form of pictures and video.

Two or three further incisions are made (5-10 mm) to insert various instruments so that surgery can be carried out. This is often likened to painting a hallway through a letterbox! This is a complex skill acquired through many hours of practice and simulation training.

Laparoscopic surgery has many advantages:

• Shorter hospital stay and quick recovery
• Reduced bleeding and tissue handling during surgery thus minimising risk of adhesion (scar-tissue) formation after surgery
• Better visualisation and access for the surgeon
• Less post-operative pain
• Reduced risk of infection and thrombo-embolism (blood clot in legs or lungs)
• Smaller incisions which are cosmetically much superior
• Early return to work and normal life

Like any operative procedure, laparoscopic surgery is not without risks. Common risks are bleeding, haematoma (collection of blood or bruising), infection, injury to intra-abdominal structures and risk of conversion to laparotomy (open operation).

Even though laparoscopic surgery is carried out by most gynaecologists, only a few will be able to perform advanced complex procedures. Experience, dexterity, expertise, surgical acumen and decision-making skills are attributes required to make a good laparoscopic surgeon.

No! Benefits of laparoscopic surgery are even more relevant for overweight patients. Infection-risk is reduced as large abdominal incisions are avoided. Early mobilisation and discharge means that risk of thrombo-embolism (blood clot) is minimised.

Please download these leaflets from the Royal College of Obstetricians and Gynaecologists, which gives excellent summary of what to expect after a laparoscopy and laparoscopic hysterectomy.

Recovering after Laparoscopy

Recovering after Laparoscopic Hysterectomy