Laparoscopy (key-hole surgery) is a minimal access procedure used frequently in gynaecology.
It is either diagnostic or operative.
It has numerous advantages which include less operative blood loss, no large skin scars(cosmesis), less pain and analgesia requirement, the ability to discharge patient on the same day and quicker recovery for the patient and return to normal activities and employment.
Diagnostic laparoscopy is used to diagnose causes of chronic pelvic pain like endometriosis and adhesions which could have been caused by endometriosis or pelvic inflammatory disease.
Operative laparoscopy is used to remove endometriosis, ovarian cysts and to perform hysterectomy.
Prior to performing a laparoscopic procedure, one has to counsel the patient, firstly the indication for doing the surgery.
Then one has to explain the procedure itself, where a special needle is placed through the umbilicus whilst the patient is asleep and air(carbon dioxide) via the needle blows up the patients abdomen then a camera is put in under vision thru the umbilicus, then 2 other incisions are made depending on the surgery which is being done in the lower abdomen under direct vision for the use of the operating instruments.
It is under the first 2 steps that serious risks can occur though very rare which include injury to the bowel or blood vessels at a rate of 1:500, if anyone occurs then it is repaired, and this is explained to the patient when counselling them even though the risk is small.
Frequent risks include wound infection, bleeding/bruising and shoulder tip pain which are self-limiting.
In diagnostic laparoscopy on entering the abdomen, one inspects the female internal organs, this includes the uterus and tubes and the ovaries, the bladder is checked and the Pouch of Douglas which is the space between the back of the uterus and the rectum, then the upper abdomen is inspected.
At this point we are looking for signs of endometriosis which include darkened areas in the pelvis and adhesions or pale areas, these will need to be treated by either excision or by thermal ablation, any scar tissue is removed to return the pelvis to normal anatomy, it is only if there is deep infiltrating endometriosis is diagnosed that a decision will have to be made for further complex surgery at a later date.
Operative laparoscopy is where operations usually done traditionally via the open abdominal route are done via the open route, these include hysterectomy, myomectomy, removal of a fallopian tube for ectopic pregnancy and removal of the ovary called oophorectomy.
Laparoscopic removal offers many advantages over the traditional routes and offer quicker return to normality.
In conclusion laparoscopic techniques both diagnostic offer significant advantages over the traditional route and should be done as first line over the traditional route.
Dr John Barker Bsc MBBS MRCOG, Dip (Risk Management) is Obstetrician/Gynaecologist at Arnos Vale Medical Center, Consultant Obstetrician/Gynaecologist UK
He has completed the Advanced Training Skills Module in Benign Gynaecology in the UK and has an interest in advanced laparoscopic and hysteroscopic
([email protected], [email protected])