Laparoscopic (Keyhole) Surgery Singapore

Dr Kelly Loi is a a strong proponent of minimally invasive surgery. She was awarded a fellowship to undergo advanced training under the distinguished tutelage of Professor Jacques Donnez, a world-renowned laparoscopic surgeon and pioneer in the fields of endometriosis and fertility preservation.

What is Minimally Invasive or Laparoscopic Surgery?

Minimally invasive surgery, also known as laparoscopic or key- hole surgery involves the insertion of a fine 5- 10mm diameter telescope through tiny stab incisions in the abdomen to allow for magnified views of the reproductive organs.

What is Hysteroscopic Surgery?

This involves the insertion of a fine telescopic device through the vagina into the uterus to view the uterine cavity. Such a procedure can allow for treatment of certain conditions of the uterus including endometrial polyps and submucous fibroids.

What is Hydrotubation?

During laparoscopic surgery, hydrotubation may be performed concurrently to assess for blockage of the Fallopian tubes in patients who desire fertility. Hydrotubation involves injection of a blue dye into the uterus to see if the tubes are blocked. If so, surgery may be performed to unblock the tubes.

How is minimally invasive laparoscopic surgery different from traditional open surgery?

The main difference between minimally invasive laparoscopic surgery and traditional open surgery is the way in which access into the abdominal cavity is obtained. In open surgery, a large 5 to over 20 cm incision is needed while in minimally invasive surgery, small 0.5 to 1.0 cm stab incisions are made into the abdominal cavity to allow the procedures to be carried out. This is done with the aid of a fine telescopic device, a light source, carbon dioxide insufflator and specialised long instruments. The actual surgery is the same as with the open procedure.

What are some of the advantages of minimally invasive laparoscopic surgery?

With this approach, there are many advantages including:

• magnified views
• reduced bleeding
• reduced infection
• faster recovery
• smaller scars

As everything is done under magnification, there tends to be better visualization during the surgery, and this may help to reduce bleeding and the need for blood transfusions. 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, return home earlier and have less wound complications. Of course cosmetically, the scar being much smaller is also less visible.

How long has minimally invasive or laparoscopic surgery been performed for gynaecological conditions?

Minimally invasive surgery or laparoscopic 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, simple procedures such as fallopian tube ligation for contraception. With time, as both doctors and patients began to realise how beneficial this approach was for the patient compared to traditional open surgery, the demand for laparoscopic surgery has increased. Together with improvements in technology, equipment as well as surgical skills and training, minimally invasive or laparoscopic surgery has now become widespread and the main approach for a wide range of conditions for laparoscopically- trained surgeons.

When should minimally invasive laparoscopic surgery performed?

Laparoscopic surgery can be performed for women with a wide range of gynaecology conditions including cysts, fibroids and endometriosis as well as ectopic pregnancies. Before undergoing infertility treatment such as IVF, laparascopic surgery is recommended for special cases. For women suffering from infertility in particular, laparosocopic surgery is very useful for diagnosing the cause and treating the condition. Some conditions which can lead to infertility and which may benefit from laparoscopic surgery and treatment 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 blockage and unblock the tubes at the same time
• Endometriosis where surgery can be useful for burning or excision and clearing up of endometriotic spots and implants
• Ovarian cysts and
• Uterine fibroids where surgery can be used for treatment while conserving the ovaries and uterus

For other women who have cysts or fibroids and have been advised to remove their ovaries or uterus (womb), laparoscopic oophorectomy (removal of ovaries) or laparoscopic hysterectomy (removal of the womb) may also be possible to avoid more painful open surgery.

Who are not suitable for minimally invasive laparoscopic surgery?

With the current expertise available, practically all types of patient can undergo laparoscopic surgery. However there are some groups of patients who may be unsuitable. These include patients with severe heart disease, or those suffering from severe bleeding with unstable blood pressure.

What preparation is needed after minimally invasive laparoscopic surgery?

For patients keen to undergo laparoscopic surgery, a thorough evaluation beforehand is recommended 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.

Who are not suitable for minimally invasive laparoscopic surgery?

Following the procedure, discharge from hospital is possible either on the same day or in one to two days. Depending on the procedure most people 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. On discharge, wound dressings should be kept clean and dry for a week until further review. Carrying of any heavy weights should also be avoided.

How long will it take for full recovery?

Following minimally invasive laparoscopic surgery on the abdomen:

• The general anaesthesia required during the surgery usually has some sedative effects which wear off soon after surgery
• Aches in the shoulder area are quite common and usually disappear after a few days
• Abdominal bloatedness is also quite common and also improves within a few days
• Discomfort in the incision sites ease off within a few days and the incisions heal after about five days