Minimally Invasive Surgery in Gynaecology
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 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 520cm 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, laparoscopic 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 discharged 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.