Gynaec Laparoscopic Surgery

Ashwini Hospital & Endoscopy Centre
When can I get back to work?

Usually a weeks rest from the day of surgery should suffice. But it would be advisable for the surgeon to advice based on your progress.

Do I have to take absolute bed rest?

No. The advantage of this method as has been previously mentioned is that the incisions are very small, thereby reducing pain and danger of hernia. You can become ambulant as early as pain and anaesthetic factors permit.

Is it more expensive than open surgery?

The equipment, maintenance and procedure.

Introduction

The laparoscope is a fibre-optic telescope designed to allow the surgeon to visualize and examine the organs lying within the pelvic and abdominal cavities. Laparoscopy is the term used to describe the operative procedure and may be used to aid diagnosis where this cannot be made by physical examination or symptom description and to facilitate treatment for some gynaecological conditions.

Indications

Diagnostic Laparoscopy can be used for:

  • Investigation of pelvic pain
  • Investigation of infertility
  • Examination of cysts and tumours
  • To obtain biopsy samples
  • To investigate suspected ectopic pregnancy

Operative Laparoscopy is utilised:

  • To achieve female sterilisation
  • For treatment of ectopic pregnancy
  • To release/remove pelvic or abdominal adhesions
  • To surgically treat endometriosis
  • To excise or drain ovarian cysts
  • To remove fibroid (benign) tumours from the uterus
  • To enhance fertility eg: assisted reproductive techniques
  • To facilitate hysterectomy
  • To reconstruct the pelvic floor, treat prolapse and incontinence

At times a surgeon may extend a diagnostic procedure and undertake concurrent laparoscopic operative surgery to improve treatment, speed recovery and to avoid further hospitalisation and anaesthesia. In such cases your gynaecologist is likely to have discussed this possibility before surgery. Other operations are sometimes performed in conjunction with laparoscopy - For example:

  • Dilatation and curettage (D & C - stripping of the uterine lining)
  • Hysteroscopy (telescopic examination of the uterine lining)
  • Dye perfusion (passing dye through the fallopian tubes to check on tubal patency)

In all of these situations your surgeon will discuss the additional procedure.

How is laparoscopic surgery performed?

Most frequently the operation is performed under light general anaesthesia and the patient is seen prior to surgery by the specialist anaesthetist who will explain that part of your operation. Prior to operation, medication is sometimes given to help you feel relaxed before your trip to the operating theatre. After preparing the skin area with antiseptic solution a small cut is made just below the umbilicus (navel) and through this incision the operating telescope (laparoscope) is inserted. During the operation carbon dioxide gas is introduced to distend the abdominal and pelvic cavity to create a space in which the organs can be seen. When necessary, separate small incisions are made low down and at the sides of the abdomen to allow insertion of other fine instruments, e.g. grasping forceps, scissors, etc., and these will enable organs and tissue to be grasped, moved or cut as is required for your surgery. At the conclusion of the surgery and after the instruments are removed, the carbon dioxide gas is encouraged to escape from the cavity and the incisions are closed with sutures or steristrip tape. Small dressings are often applied to cover these wounds.

Conclusion

In general, laparoscopic surgical techniques allow excellent diagnostic inspection of abdominal and pelvic organs and facilitate operative correction of gynaecological disorders without the necessity for large abdominal incisions, prolonged hospitalization and protracted recuperation. The gynaecologists at the Oxford Clinic are skilled in advanced laparoscopic surgical techniques and encourage you and your partner to discuss your planned surgery and expectations with them. They welcome input from your family practitioner and will ensure that he or she is aware of our surgery and expected post-operative course.

What can you expect?

Laparoscopy is direct visualization of the peritoneal cavity, ovaries, outside of the tubes and uterus by using a laparoscopy. The laparoscopy is an instrument somewhat like a miniature telescope with a fiber optic system which brings light into the abdomen. It is about as big around as a fountain pen and twice as long. An instrument to move the uterus during surgery will be placed in the vagina. Carbon dioxide (CO2) is put into the abdomen through a special needle that is inserted just below the navel. This gas helps to separate the organs inside the abdominal cavity, making it easier for the physician to see the reproductive organs during laparoscopy. The gas is removed at the end of the procedure.

Microlaparoscopy a new minimally invasive diagnostic surgical procedure uses telescopes and instruments that are much smaller than normal. If this procedure is appropriate for your condition, smaller incisions will be made and postoperative abdominal tenderness may be reduced.