laparoscopic
surgery in
gynaecology

Minimally invasive surgery or laparoscopicopic surgery has become increasingly popular since the early 90s. In the early days, the only specialty performing laparoscopy on a widespread basis was gynaecology, mostly for relatively short and simple procedures such as fallopian tube ligation for contraception. Together with improvements in technology, equipment, surgical skills and training, laparoscopic surgery has now become widespread and is the main approach for a wide range of conditions.

The main difference between minimally invasive surgery and open surgery is the way in which access into the abdominal cavity is obtained. In open surgery, a large incision of 5-20cm is needed. In laparoscopic surgery, several small 0.5-1cm stab incisions are made to allow the procedures to be carried out. This is done with the aid of a fine telescope, a light source, a carbon dioxide insufflator and specialised long instruments. The actual surgery is the same as with the open procedure.

The many advantages of a laparoscopic procedure include: magnified views; reduced bleeding; reduced infection; faster recovery and much smaller scars. As everything is done under magnification, there tends to be better visualisation during the surgery, and this may help to reduce bleeding. With less exposure of the internal organs to the external environment there is also less risk of infection. Furthermore, without a large painful incision, the patient can recover faster with less need for painkillers and return home earlier. And cosmetically the scar is much smaller.

Laparoscopic surgery can be performed on women with a wide range of gynaecology conditions. For women suffering from infertility in particular, laparosocopic surgery is very useful for diagnosing the cause and treating the condition. Conditions which can lead to infertility and which may benefit from laparoscopic surgery include: polycystic ovary disease where laparoscopic ovarian drilling can be performed to allow ovulation to occur; blocked fallopian tubes where surgery can be performed to confirm the site of a blockage and unblock the tubes at the same time; endometriosis where surgery can be useful for clearing up of endometriotic spots and implants and ovarian cysts and uterine fibroids where surgery can be used for treatment while conserving the ovaries and uterus.
During laparoscopic surgery, it may be useful to have a hysteroscopy performed at the same time. Here, a fine telescope is passed through the vagina into the uterus. This would allow the removal of any endometrial polyps that can affect implantation and pregnancy, and to ensure the lining of the uterus is smooth.
With the current expertise available, practically all types of patients can undergo laparoscopic surgery. However there are some groups of patients who may be unsuitable. These include patients who are medically unfit with severe

heart disease, or those suffering from severe bleeding with unstable blood pressure. Other relative contraindications to laparoscopic surgery depend on the surgery needed and the surgeon’s expertise. Even pregnant patients, who were once thought unsuitable, can now undergo laparoscopic surgery in expert hands.
For patients keen to undergo laparoscopic surgery, I would advise a thorough evaluation beforehand to confirm that the laparoscopic approach is suitable and she is medically fit for the procedure. Pre-op preparation would also usually include some simple blood tests and bowel preparation. Following the procedure, patients should be monitored to ensure a smooth recovery before being dischargeed from the hospital. On discharge, the wound dressings should be kept clean and dry for a week until further review by her doctor. Carrying any heavy weights should also be avoided. Depending on the procedure, most patients will feel well enough to return to normal daily activities two to three days after laparoscopy, although some people may need one to two weeks of rest.