Advanced Laparoscopic (key hole) procedures

About laparoscopic surgery

Laparoscopy is a minimally-invasive procedure that is performed using a thin fibre-optic instrument with a camera and lens attached to it, called a laparoscope. A laparoscope can be used to diagnose and treat various conditions.

What gynaecological laparoscopic surgery is used for

In gynaecology, a laparoscopy can be used to check for abnormalities in the ovaries, uterus, fallopian tubes and other organs that are not evident using other diagnostic procedures. It can be used for diagnosis and treating conditions such as infertility, endometriosis, pelvic inflammatory disease, pelvic pain, cysts, ectopic pregnancies, fibroids, tumours and other gynaecological problems.

Pelvic pain can be a characteristic of a number of gynaecological conditions and assessing the exact cause is essential in treating the condition. A laparoscopy can help in assessing what is causing your pain.

How gynaecological laparoscopic surgery is performed

During the procedure, your surgeon will make a small incision at or below the belly button and insert a tube that helps guide the laparoscope into the abdomen. The images of the laparoscope are projected onto a screen so the surgeon can see inside your body.

A contrast dye may be injected before the procedure for better visualisation of the fallopian tubes. The incision is closed with stitches and covered with bandages after the procedure is over.

You will be taken through the procedure step-by-step to ensure you are aware of any risks or benefits so you can make an informed choice. Laparoscopic surgery is performed when possible over other invasive techniques, as it is simple, has a short hospital stay, minimal scarring and faster recovery time.

Gynaecological conditions we use laparoscopic surgery to investigate/treat

Laparoscopy involves inspecting or operating on the inside of the abdomen or pelvis through keyhole cuts to avoid the need for larger incisions. The abdomen will be inflated with carbon dioxide and small cuts are made so a camera can be passed into the body. The cuts do not normally require stitches and only need skin glue to close them.

There are some major advantages to laparoscopy over surgeries that require larger incisions, which includes faster recovery time, shorter hospital stay, reduced post-op pain, reduced risk of adhesion formation, and a more aesthetically pleasing and smaller scar.

Some of the conditions laparoscopy can treat or investigate includes:

  • Reversal of sterilisation
  • Uterine cerclage
  • Tubal surgery
  • Excision of endometriosis
  • Excision of ovarian cysts
  • Hysterectomy
  • Myomectomy
  • Adhesiolysis

Reversal of sterilisation

A laparoscopy can be used to reverse the tying of the fallopian tubes in a woman who was sterilised, but decides they want to try to have a baby. This procedure carries a success rate of roughly 85 per cent. The advantage of this treatment option over IVF is that a woman may be able to have more children without needing more medical intervention. This is a procedure with no hospital stay and roughly two weeks recovery.

Uterine cerclage

A uterine cerclage is a permanent stitch placed around the neck of the womb in women who have had multiple mid-pregnancy miscarriages and for whom vaginal or cervical stitches have been unsuccessful. This procedure has about a two-week recovery with no hospital stay.

Tubal surgery

A laparoscopy is able to repair or reopen the fallopian tubes in women with certain types of tubal infertility to help them conceive naturally. This given women a better chance of conceiving again in the future without the need for medical intervention.

Excision of endometriosis

Laparoscopy can be used to treat mild cases of endometriosis, all the way to more complex procedures. The simpler procedure will not require any hospital stay and two weeks recuperation, while more radical procedures will require up to two days hospital stay and four weeks recuperation.

Excision of ovarian cysts

A laparoscopy can help with the removal of troublesome ovarian cysts, while retaining healthy ovarian tissue to allow the continuation of normal function. This procedure requires no hospital stay and only needs about two weeks recuperation.

Hysterectomy

A laparoscope allows for the total hysterectomy (removal to the entire womb) or for subtotal hysterectomy (removal of the womb without the cervix). This involves a half day hospital stay and four weeks recovery time.

Myomectomy

A laparoscopic myomectomy is the removal of uterine fibroids from the uterus without damaging it, for women who wish to retain their fertility. This normally involves half a day stay in hospital and roughly four weeks recuperation.

Adhesiolysis

Sometimes bands of scar tissue can be associated with pelvic pain, which can cause a delay in conceiving and interfere with bowel function. This procedure requires about two weeks recovery and no hospital stay.

What are the benefits of laparoscopic surgery?

Some of the benefits of laparoscopic surgery include:

  • A shorter hospital stay
  • Less pain after surgery
  • Smaller aesthetically-pleasing abdominal scars
  • Less blood loss
  • Reduced risk of long-term infertility complications, pelvic pain and intestinal obstruction
  • Faster recovery time
  • Better post-op satisfaction

Risks of laparoscopic surgery

Laparoscopic surgery is often judged to be safer than other traditional abdominal surgeries. No operation is risk free, however, and some of the potential risks include:

  • Bleeding
  • Abdominal organ injury
  • Adhesion formation
  • Infection
  • Deep vein thrombosis
  • Conversion to abdominal surgery

Bleeding

Bleeding can occur during or after the operation and can lead to the collection of blood in the pelvis, which is known as a haematoma. Excessive bleeding is uncommon during or following a laparoscopic surgery, but if it occurs, may require a blood transfusion.

Abdominal organ injury

There is a very small chance of any abdominal organ being injured during a laparoscopic procedure, though this is usually treatable at the time of the operation. The organs most at risk of injury are the uterus, bladder and intestines.

Adhesion formation

The formation of adhesions complicates all types of surgery, but has been shown to be less likely with laparoscopic surgery.

Infection

Infections can affect the urinary tract, pelvis or abdomen, but are rare in association with laparoscopy. Some women may develop a brief high temperature within 24 hours of the operation, but this is not an infection and does not require any special treatment.

Antibiotics are usually used during the procedure to reduce the risk of infection, and if an infection is developed later, it often responds well to further antibiotic treatment.

Deep vein thrombosis (blood clots)

Laparoscopic surgery offers a lower risk of blood clot formation compared to traditional abdominal surgery. There are strategies that are put in place to further reduce the risk of blood clot formation.

Conversion to abdominal surgery

It is occasionally decided that it is safer to abandon the laparoscopic surgery and finish the surgery with a more traditional method. The risk depends on how complex the procedure is, but less than 1 in every 100 procedures require this.

Your doctor will explain all the risks and benefits of your investigations and treatments beforehand.