Laparoscopic Surgery

Laparoscopic surgery

Laparoscopic surgery can also be referred to as “keyhole surgery”, “minimally invasive surgery” or “minimal access surgery” and can be used to replace the traditional open surgery which would often lead to bikini line cuts or more unsightly up and down cuts on the lower abdomen.

Some common conditions that can be investigated and treated this way include:

• Ovarian cysts
• Endometriosis
• Infertility
• Pelvic Pain
• Hysterectomy
• Ectopic Pregnancy

The main advantages of laparoscopic surgery compared to traditional surgery include:

• Less pain following the procedure
• Shorter hospital stay
• Quicker recovery
• Much smaller scar

Diagnostic laparoscopy

As laparoscopy provides such a good view of the womb, tubes and ovaries and surrounding tissues/organs, it is an ideal tool for diagnosing certain problems or condtions. For example in the case of subfertility, laparoscopy is often combined with hysteroscopy (looking inside the womb). If a problem is found, such as adhesions or endometriosis, then in many cases it can be treated at the same time to avoid the need for another operation. The tubes can also be checked to see if they are open. Diagnostic laparoscopy is usually done under general anaesthesia with women fit to go home the same day.

Laparoscopic surgery for ovarian cysts

Ovarian cysts are collection of fluid, which is surrounded by a thin wall within the ovary. They are very common, usually harmless (benign) and most of the times functional (self limiting). Ovarian cysts can affect women in all age groups but more commonly women of childbearing age.

There are different types of ovarian cysts, for instance, functional ovarian cysts can come and go during the normal monthly menstrual cycle, while persistent cysts can be associated with conditions such as endometriosis.

Surgical removal is usually advisable if a cyst persists, it is relatively large, it causes symptoms such as pain, or if its nature is unclear. The choice is between removing the cyst only or removing the whole ovary containing the cyst. Sometimes (e.g. if you are post-menopausal), it is reasonable to remove both ovaries even if only one is abnormal to avoid future problems in the remaining ovary. Laparoscopic surgery for ovarian cysts is an established procedure, so in many cases this procedure is used, rather than open surgery.

Laparoscopic surgery for endometriosis

Endometriosis is the presence of endometrial-like cells (which are normally found within the lining of the womb) outside the womb, inside the abdomen. Endometriosis is under the influence of female hormones. Endometriosis is very common and it is present in 5-10% of women in reproductive age. The main symptom is pelvic pain and endometriosis is common in women with infertility.

Although endometriosis can be treated medically with hormones, side-effects and the need for prolonged therapy can make surgery an attractive alternative. Laparoscopy can then often be used to destroy or excise the deposits of endometriosis (either using laser or diathermy-heat), remove endometriomas and free adhesions with the aim of improving symptoms almost immediately.

Surgery can however be technically difficult when the endometriosis is severe with dense adhesions or deep deposits, and sometimes it is preferable to leave some deposits rather than risk a major complication (e.g. bowel injury). If surgery is incomplete, you may be recommended to take medical treatment for a few months after the procedure.

Laparoscopic surgery for pelvic pain

There can be several reasons for chronic pain, but the three most common causes are endometriosis, irritable bowel syndrome and interstitial cystitis (a condition affecting the bladder). Other gynaecological causes include pelvic adhesions (scar tissue), chronic pelvic inflammatory disease, ovarian cysts, ovarian remnant (ovarian tissue left after surgical removal of an ovary), trapped ovary (retained ovary buried in adhesions after hysterectomy), and pelvic varicosities. Non-gynaecological causes include nerve entrapment in scar tissue, inflammatory bowel disease, constipation, various musculo-skeletal problems and hernias. Psychological factors can also play an important role.

The advantage of laparoscopy is that it’s not only useful in finding the cause, but can be used for treatment. However, as is the case with any pain symptom, cure can never be guaranteed.

Laparoscopic hysterectomy

Hysterectomy is the surgical removal of the uterus. Traditionally this operation was performed as open surgery, but with the recent advances of laparoscopic techniques, total laparoscopic hysterectomy is feasible. The uterus is disconnected from its attachments and the uterus is passed through the vagina, which is then sutured. However, there are situations that abdominal hysterectomy is the only realistic option such as very large fibroid uterus.

There are different indications for hysterectomy such as fibroids, endometriosis, adenomyosis (endometriosis growing within the womb), uterine prolapse, heavy or abnormal bleeding and three forms of cancer (uterine, cervical and ovarian).

There are several types of laparoscopic hysterectomy depending on what proportion of the surgery is done laparoscopically, and what proportion is done vaginally as in most cases the uterus is in fact removed via the vagina. At one end of the spectrum, a laparoscopy is done for diagnostic purposes, and if no significant pathology is found, a vaginal hysterectomy is done without any laparoscopic surgery as such. At the other end of the spectrum, the hysterectomy is done purely laparoscopically with no vaginal surgery at all. Most gynaecologists practise the intermediate procedure of what is called “laparoscopically assisted vaginal hysterectomy”, that is, some of the surgery is done laparoscopically and some vaginally.

The major advantage of laparoscopic hysterectomy over abdominal hysterectomy is that your recovery will be faster, much more like the situation after vaginal hysterectomy. The major disadvantage of laparoscopic hysterectomy is that major complications are slightly more likely, particularly in terms of bleeding and bladder injury.

Laparoscopic surgery for ectopic pregnancy

An ectopic pregnancy is a complication of pregnancy in which the pregnancy implants outside the uterus (womb). With rare exceptions, ectopic pregnancies are not viable. Furthermore, they are dangerous for the mother, internal bleeding being a common complication. Most ectopic pregnancies occur in the Fallopian tube (so-called tubal pregnancies), but implantation can also occur in the cervix, ovaries, and abdomen. An ectopic pregnancy is a potential medical emergency and, if not treated properly, can lead to death.

Symptoms include pain, bleeding or collapse, and diagnosis is made with the use of the ultrasound and/or abnormal rise of the pregnancy hormone in the blood (bHCG).

Although medical treatment can be an option, if there is evidence of internal bleeding then surgical intervention may be indicated. Laparoscopy confirms the diagnosis and treatment can be carried out at the same time. Treatment includes either the removal of the affected fallopian tube containing the pregnancy or just the removal of the pregnancy within the fallopian tube, leaving the tube behind.