Laparoscopic Gynaecology Surgery
Laparoscopic gynaecology surgery , also known as keyhole surgery or minimal access surgery, has now firmly been established as the gold standard for most gynaecological problems needing surgery. It is a procedure used to examine the uterus, fallopian tubes & ovaries and the surrounding organs in the abdominal cavity. It can be used to diagnose a condition as well as to simultaneously treat the problem in the same sitting.
Laparoscopic and hysteroscopic surgery need a special and additional training after laparotomy training.
Basic training in gynaecology permits simple surgery as ovariectomy and cystectomy .
- Level 1 permits a total laparoscopic hysterectomy (TLH) up to 500-800 grams. During the learning curve often a laparoscopic assisted hysterectomyis performed (LAVH).
- Level 2 means dissection and suturing together with a more advanced knowledge of anatomy. This is required for pelvic floor surgery the promontofixation and lymadenectomy for cancer .
- Level 3 is advanced laparoscopic surgery When the anatomy is stronly alterated and when other organs as bowels, bladder and ureter are involved more and additional experience is necessary. In addition during surgery the risk and the advantages of a complete excision of endometriosis have to be balanced. This is the surgery of deep endometriosis and debulking for disseminated ovarian cancer .
How is it performed ?
Laparoscopic gynaecology surgery is performed through tiny abdominal cuts of 0.5cm to 1 cm near the umbilicus ( belly button) and on either side of the abdomen ( this is as opposed to a cut of about 10 – 15 cm in conventional open surgery ! ). It is carried out under general anesthesia as a day care procedure, but sometimes may require 1-2 days’ hospitalization depending upon the type of surgery.
A thin instrument, called a laparoscope ( which is actually a telescope with an attached camera & light source) is inserted through a tiny cut under the umbilicus into the abdomen to help your doctor look, examine & operate in your abdomen without making large cuts. Special fibreoptic wires transmit the image from the laparoscope to a video monitor screen, which the surgeon views in real time & performs the surgery.
What are the preparations required ?
Any preparations required would depend upon the reason for the procedure. For elective & planned procedures, a few blood tests, ECG & chest X-ray are needed to ensure that it is safe to give anesthesia & perform surgery over the patient.
When is surgery required ? (Indications for Lap. Surgery)
Laparoscopic gynaecology surgery may be required in gynaecology to perform the following procedures.
- Removal of uterine fibroids
- Removal of uterus
- For diagnosis & treatment of endometriosis ( a condition where the lining tissue of uterus implants & grows at places outside the uterus)
- Remove ovarian cysts
- For repair of pelvic organ prolapse
- For treatment of ectopic pregnancy ( a condition where the embryo is implanted outside the uterus)
- Investigate the causes of and to treat infertility
- Laparoscopic tubal sterilization ( permanent contraception)
- Diagnose & remove scar tissue due to previous surgery or infections
What are the alternatives to Laparoscopy ?
In cases where laparoscopy is performed for diagnostic purpose, some help may be taken by imaging modalities like ultrasound & CT scan/MRI ; but these modalities have their limitations & laparoscopy forms the gold standard for diagnosis & treatment of conditions like endometriosis & for obtaining intra abdominal biopsies for diagnosing tuberculosis or malignances.
In patients where a surgical procedure is required, the option of going for different type of surgery is available eg, Hysterectomy may be performed by the abdominal route , i.e. by making a large cut in the lower abdomen or a vaginal route also. The selection of the route of surgery is, however, best left to the doctor .
What are the advantages of Laparoscopic Gynaecology Surgery ?
Laparoscopy results in relatively little pain & a quick recovery for most patients.
- It is minimally invasive.
- It results in speedy post operative recovery & ambulation.
- The duration of hospitalization is much shorter.
- It is performed under magnification & hence is more precise.
- It gives cosmetically better acceptable scars postoperatively.
- The blood loss during surgery is relatively lesser.
- Tissue handling is minimal, hence lesser adhesions are formed post operatively .
What are the Risks & Complications ?
No surgical procedure is completely without risks, but gynaecological laparoscopy is a commonly performed & a relatively safe procedure ; and for most people the advantages in terms of improved symptoms, of having a clear diagnosis of the problem, far outweigh the risks. However, patients should be aware of the possible complications which may be:-risk of an unexpected or allergic reaction to anaesthetic agent, excess bleeding, infection, injury to bladder, intestines or other surrounding organs or major blood vessel.
Is it more expensive ?
The equipment cost & maintenance raise the cost of the surgery but as the hospital stay & intake of drugs is reduced, the final cost is almost the same, if not less, than open surgery.
When to visit the doctor ?
Usually , the patients are called for a follow up visit after a week, but if you have fever, severe pain abdomen, foul smelling discharge or heavy bleeding; you should consult sooner rather than later.
Endoscopic surgery has important advantages over open surgery. Postoperative pain is less whereas the recovery, hospitalization discharge and absence from work are faster. This has been proven today for most gynecologic interventions such as hysterectomy, pelvic floor surgery, fertility surgery, cancer surgery and endometriosis surgery.
Post operative recovery
Post op you are transferred to the recovery room where you are observed closely & your vitals signs monitored for a few hours. During this time, you may have shoulder tip pain, pain in abdomen, nausea or vomiting ; which is easily treated by appropriate medication.
When can I go home?
Most diagnostic procedures are done on a day care basis & you may go home the same day after you have recovered completely from the anaesthesia & are feeling alright. You should, however not be driving or going back alone & should have a family member or friend to stay with you for the first day at least.
For operative laparoscopy; where dissection & surgery has been done, overnight hospital stay for up to 1-2 days may be required.
For the best Laparoscopic Surgeon in South City 2, Gurgaon consult Dr. Smita Vats ( Best Gynaecologist in South City-II , Gurgaon )