Laparoscopic Surgery in Gynaecology

Generally, there are two ways of performing gynaecological surgery: laparotomy and laparoscopy. Laparotomy is also the conventional open surgery, where an incision of several inches long is required. Two of the most common incisions for laparotomy in gynaecology are the lower midline incision, a vertical incision below the umbilicus, and the Pfannenstiel incision, a transverse incision just above the pubis.

The laparoscopy, on the other hand, is performed through several small "keyhole" incisions in the abdomen, where instruments like a laparoscope (a thin telescope-like instrument), scissors and graspers are inserted.

Laparoscopy Incisions
Figure 1: Four keyhole
incisions in laparoscopy
where trocars of diameter
10mm and 5mm are inserted.

When is laparoscopy needed?

Laparoscopy is performed either for diagnostic or operative purposes. Diagnostic laparoscopy is a procedure that allows the doctor to directly view the pelvic organs to investigate pelvic pain, infertility, suspected ectopic pregnancy, endometriosis, etc. Usually it is recommended when the cause or symptom of a disease cannot be confirmed via other diagnostic tests, such as ordinary questioning, physical examination, ultrasound and radiological (X-ray) examinations . Operative laparoscopy allows doctor to perform gynaecological surgeries at a minimally-invasive manner.

Preparing for a Laparoscopy Surgery

Patient needs to be fasted for at least 6 hours before the surgery. In some surgeries, patient may be given medication to empty the bowel.

How is Laparoscopic Surgery Performed?

Laparoscopic surgery is performed under general anaesthesia. Prior to the laparoscopy, a Foley catheter may be inserted into the bladder to drain the urine during the surgery (see Figure 2). A 10 mm incision is made at the umbilicus and a Veress needle is inserted into the abdomen. The Veress

Foley catheter
Figure 2: A Foley catheter is inserted to empty the bladder prior to the surgery.

needle is then connected to a CO2 insufflation tubing. Gas is passed into the abdominal cavity to distend the abdomen, so as to allow the doctor to see the pelvic organs and to perform the surgery more easily. A 10 mm trocar is placed at the umbilicus, followed by several 5 mm trocars, which are placed at the lower abdomen.

A laparoscope attached to a video camera is passed through the 10 mm port. Video images captured by the video camera are displayed on a video monitor. A powerful light source is channeled into the abdominal cavity for illumination purpose. Instruments like laparoscopic scissors, graspers are also inserted through other 5mm ports to perform the surgery (see Figure 3). At the end of the surgery, all the instruments are removed and the CO2 gas is released. The incisions are either sutured or taped. In some patients, a drainage tube is left in the pelvis to drain out any fluid that may accumulate after the surgery.

Laparoscopic surgery
Figure 3: The laparoscopic surgery.

Advantages of Laparoscopic Surgery

Postoperative Care

Patient is allowed to drink some clear fluids after surgery. Once she has passed flatus, she is allowed to consume other drinks and later solid food. The drainage tube in patient's bladder may be removed immediately after the surgery or several days later, depending on the type of surgery. For minor laparoscopic surgery, patient may resume normal activities and sexual intercourse within a few days. In major laparoscopic procedures, light physical activities can be performed in about one week. Sexual intercourse may only be possible after about six to eight weeks.

Possible Postoperative Effects of Laparoscopic Surgery

Risks of Laparoscopic Surgery

If the injuries are detected during the surgery, emergency surgery is necessary to repair the damaged sites. This is usually done laparoscopically but sometimes a laparotomy may be needed. Otherwise, if the injuries are not detected immediately and are only discovered during the recovery period, a second surgery may be required. Certain patients may require blood transfusion during or after the surgery.

Suitable Candidate for Laparoscopic Surgery

Patients with the following conditions may not be suitable to undergo laparoscopic surgery:

All in all, a doctor's own skills and experience are crucial in determining whether he can perform the surgery laparoscopically. Doctors who have only received basic laparoscopy training, could not perform more advanced and complicated laparoscopic surgeries.

Lastly, the above information merely serves as guidelines. It is always best to consult your doctor to find out if you are a candidate for laparoscopic surgery.

Gynaecological surgeries that can be performed laparoscopically
Related Links

Lower Midline Incision

Lower midline incision

Pfannenstiel Incision

Pfannenstiel incision

Veress Needle

Veress needle

10 mm Trocar

10 mm trocar

5 mm Trocar

5 mm trocar

Laparoscope

Laparoscope

Miniature Video Camera

Miniature video camera

Laparoscopic Grasper

Laparoscopic graspher