LAPAROSCOPY

Laparoscopy is a type of surgical procedure that allows a surgeon to access the inside of the abdomen (tummy) and pelvis without having to make large incisions in the skin. This procedure is also known as keyhole surgery or minimally invasive surgery. Large incisions can be avoided during laparoscopy because the surgeon uses an instrument called a laparoscope. This is a small tube that has a light source and a camera, which relays images of the inside of the abdomen or pelvis to a television monitor.

 

 

 

 

 

 

 

 

 

 

The advantages of this technique over traditional open surgery include:

• a shorter hospital stay and faster recovery time
• less pain and bleeding after the operation
• reduced scarring

When laparoscopy is used

Laparoscopy can be used to help diagnose a wide range of conditions that develop inside the abdomen or pelvis. It can also be used to carry out surgical procedures, such as removing a damaged or diseased organ, or removing a tissue sample for further testing (biopsy).

How laparoscopy is carried out

Laparoscopy is carried out under general anesthetic, so you won’t feel any pain during the procedure. During laparoscopy, the surgeon makes one or more small incisions in the abdomen. These allow the surgeon to insert the laparoscope, small surgical tools, and a tube used to pump gas into the abdomen. This makes it easier for the surgeon to look around and operate. After the procedure, the gas is let out of your abdomen, the incisions are closed using stitches and a dressing is applied. You can often go home on the same day of your laparoscopy, although you may need to stay in hospital overnight.

Laparoscopic Operative Procedures:

Laparoscopic Adhesiolysis

Adhesions are strands of tissue that form in the body in response to injury. Abdominal cavity is one of the commonest sites where adhesions tend to form. Looking for them through a laparoscope is the only way confirming their presence. In fact, no other test or investigation can diagnose adhesions with certainty. If the surgeon encounters adhesions, they can be easily divided using long laparoscopic instruments. The procedure is called adhesiolysis. A patient recovers quickly after laparoscopic surgery for adhesions as she has very little pain.

What are the advantages of laparoscopic adhesiolysis?

• Less pain from the incisions after surgery
• Less postoperative medication used
• Almost no chance of having hernia
• Shorter hospital stay
• Shorter recovery time
• Faster return to normal diet
• Faster return to work or normal activity
• Better cosmetic healing
• Lower chance of re-formation of the adhesions

Laparoscopic Endometriotic Intervention

Laparoscopy is the most common procedure used to diagnose and remove mild to moderate endometriosis. If your doctor recommends a laparoscopy, it will be to:

• View the internal organs to look for signs of endometriosis and other possible problems. This is the only way that endometriosis can be diagnosed with certainty. But a “no endometriosis” diagnosis is never certain. Growths (implants) can be tiny or hidden from the surgeon’s view.
• Remove any visible endometriosis implants and scar tissue that may be causing pain or infertility. If an endometriosis cyst is found growing on an ovary (endometrioma), it is likely to be removed.

Laparoscopic Ovarian Cyst Operation

Laparoscopic cystectomy is the preferred approach to managing benign ovarian cysts in adolescents and adults. A retrospective study of 282 females aged 25 years or younger who underwent laparoscopic surgery concluded that the procedure is a safe first-line strategy for cysts in this age group.

The advantages of laparoscopy over traditional abdominal ovarian cystectomy surgery include a shorter post-operative hospital stay, a shorter recovery interval and less pain.   Also since smaller instruments are used, more ovarian tissue can be spared and scarring can be minimized.

Laparoscopic Ovarian Drilling

Laparoscopic ovarian drilling is a surgical treatment that can trigger ovulation in women who have polycystic ovary syndrome (PCOS). Electro-cautery or a laser is used to destroy parts of the ovaries.

This surgery is not commonly used. But it can be an option for women who are still not ovulating after losing weight and trying fertility medicines. Destroying part of the ovaries may restore regular ovulation cycles.

Laparoscopic Tubal Recanalization

Laparoscopic tubal ligation is the most common form of female birth control. Although it is a permanent form of sterilization, some women ask for reversal of the process. Laparoscopy is the most widely used procedure for Tubal Recanalization. The major advantage is speedy recovery with minimal tissue handling.  The process is performed under a general anaesthesia.

After successful recanalization the patients are advised to try for conception from the next menstrual cycle. The fertility outcomes are favourable and it is a preferred method in many fertility centres.

Laparoscopic Myomectomy

The advantage of a laparoscopic myomectomy over an abdominal myomectomy is that several small incisions are used rather than one larger incision. Laparoscopic surgery is usually performed as out-patient surgery under general anaesthesia. The procedure can take one to three hours, depending on the number, size, and depth of the fibroids within the muscle wall. Because the incisions are small, recuperation is usually associated with minimal discomfort.

Fibroids that are attached to the outside of the uterus by a stalk (pedunculated fibroids) are the easiest to remove laparoscopically. Many sub-serous fibroids (close to the outer surface) can also be removed through the laparoscope.

Laparoscopic Tubal Ligation

Laparoscopic tubal ligation is a surgical sterilization procedure in which a woman’s fallopian tubes are either clamped and blocked or severed and sealed. Both methods prevent eggs from being fertilized. Tubal ligation is a permanent method of sterilization.

Tubal ligation can be performed in the peripartum period or at any time remote from pregnancy (referred to as interval sterilization). Approximately half of female sterilizations are interval sterilizations, and the other half are performed at the time of caesarean delivery or immediately postpartum. Most interval sterilizations are performed laparoscopically.

Laparoscopic tubal ligation has many advantages that explain its use as the interval procedure of choice. It offers the opportunity to explore pelvic and abdominal anatomy, especially if the patient has complaints such as pelvic pain. The procedure is an outpatient surgery with a rapid recovery, allowing patients to return quickly to work or home.

Laparoscopic Ectopic Pregnancy Operation

At any stage of development, surgical removal of an ectopic growth and/or the fallopian tube section where it has implanted is the fastest treatment for ectopic pregnancy. Surgery may be your only treatment option if you have internal bleeding. When possible, surgery is done through a small incision using laparoscopy. This type of surgery usually has a short recovery period.

An ectopic pregnancy can be removed from a fallopian tube by using salpingostomy or salpingectomy.

• Salpingostomy. The ectopic growth is removed through a small, lengthwise cut in the fallopian tube (linear salpingostomy). The cut is left to close by itself or is stitched closed.
• Salpingectomy. A fallopian tube segment is removed. The remaining healthy fallopian tube may be reconnected. Salpingectomy is needed when the fallopian tube is being stretched by the pregnancy and may rupture or when it has already ruptured or is very damaged.

When an ectopic pregnancy is located in an unruptured fallopian tube, every attempt is made to remove the pregnancy without removing or damaging the tube.

Emergency surgery is needed for a ruptured ectopic pregnancy.

Laparoscopic Chromopertubation

Chromopertubation is a procedure usually done during a laparoscopy to visualize the fallopian tubes in order to see if they are patent or open. It’s done during an infertility work-up. It is a procedure where a coloured dye is passed through the fallopian tubes to confirm that they are patent. The procedure is done under anaesthesia and during laparoscopy.

A chromopertubation may be called for if a patient is undergoing a surgical procedure where the fallopian tubes are visible. A dye can be introduced into the uterine cavity being injected through the cervical canal during the procedure and then observed as it comes out of the ends of the tubes into the peritoneal (abdominal) cavity.

Sometimes tubal occlusion as well as adhesions cannot be detected completely by looking at the fallopian tubes, so additional tests may be necessary to provide a full evaluation.

Laparoscopic Hysterectomy:

A laparoscopic hysterectomy is a minimally invasive surgical procedure to remove the uterus. A small incision is made in the belly button and a tiny camera is inserted. The surgeon watches the image from this camera on a TV screen and performs the operative procedure. Two or three other tiny incisions are made in the lower abdomen. Specialized instruments are inserted and used for the removal process.

Some women do not have their ovaries removed when they undergo a hysterectomy. If the ovaries stay inside, the woman does not need to take any hormones after the surgery and she does not have hot flashes. Some women remove their ovaries because of family history of ovarian cancer or they have an abnormal growth on their ovary.

Women can choose to either keep the cervix in place (called a “laparoscopic supra-cervical hysterectomy”) or remove the entire uterus and cervix (“total laparoscopic hysterectomy”).

Keeping the cervix in place makes the operation a little faster and safer. When the cervix is in place there is a 5% chance that the woman will have monthly spotting at the time of her menstrual periods. Women whose cervices stay in place need to continue getting pap smears.

If the woman wants to be 100% certain that she will never menstruate again, she needs to have the entire uterus removed. If the patient has a history of pre-cancerous changes of the cervix or uterine lining, she should have the entire uterus removed. If the operation is being done for endometriosis or pelvic pain, many doctors think the chances for pain reduction are better if the cervix is removed.

What are the advantages of a laparoscopic hysterectomy surgery?

A laparoscopic hysterectomy requires only a few small incisions, compared to a traditional abdominal hysterectomy which is done through a 3-6 inch incision. As a result, there is less blood loss, less scarring and less post-operative pain. A laparoscopic hysterectomy is usually done as an outpatient procedure whereas an abdominal hysterectomy usually requires a 2-3 day hospital stay. The recovery period for this laparoscopic procedure is 1-2 weeks, compared to 4-6 weeks after an abdominal hysterectomy.

The risks of blood loss and infection are lower with laparoscopic hysterectomy than with an abdominal hysterectomy. In experienced hands, laparoscopic hysterectomy takes about the same length of time as an abdominal hysterectomy and involves no greater risk.

Who should have laparoscopic hysterectomy surgery?

Most patients who are having a hysterectomy to treat abnormal uterine bleeding or fibroids can have a laparoscopic hysterectomy. It may not be possible in some cases. For example, if the uterus is bigger than a 4 month pregnancy, if she’s had multiple previous operations in her lower abdomen. It is usually not done for women with a gynaecologic cancer.

What preparations will be needed prior to surgery?

The surgeon may have the patient see their primary care doctor prior to surgery to make sure there are no medical conditions that may cause a problem with the surgery. There will be a pre-operative appointment prior to the day of surgery which will include a history and physical examination, blood samples, and a visit w a member of the anaesthesia department. Patients should not eat or drink anything after midnight on the night before surgery.

What type of anaesthesia will be required?

Patients are put to sleep under general anaesthesia.

Is there a hospital stay after surgery?

The majority of our patients go home the same day as their surgery.

What kind of recovery can be expected?

Patients should expect to take pain-killer pills for a few days post-operatively. We encourage patients NOT to stay in bed. They should move around the house and resume normal activities as soon as they feel up to it. Some women are well enough to return to work one week after surgery. Women who have more physically demanding work should stay home for 2-3 weeks. Women can resume exercise and sex within a few weeks of the surgery.

Laparoscopic patients can expect to suffer less post-operative pain than traditional hysterectomy or caesarean section patients.