Laparoscopic surgery is also known as “keyhole” surgery. It is a technique for performing operations through very small cuts in the tummy. Laparoscopy is one form of minimal access surgery, the other one being hysteroscopy.
How is laparoscopic surgery different from conventional “open” surgery?
In the past, gynaecological operations were performed through large cuts in the abdominal wall, around 20 cm long (approximately 8 inches), known as laparotomy. See upper picture in image.
Laparoscopy allows surgery to be performed through 3-4 small incisions, each one 0.5-1 cm long. See lower picture in image.
How is laparoscopy performed?
Laparoscopy is performed using a small telescope (called the laparoscope) connected to a camera, which projects images of the inside of the abdomen on to a television monitor. The telescope is inserted into the tummy through a small cut, 0.5-1 cm in size, often placed in the belly-button. Gas is used to inflate the tummy thereby creating a space in which to operate on the womb, Fallopian tubes, ovaries and pelvic cavity. There are usually 2 or 3 additional cuts in the tummy, each 0.5 cm long, which allow operating instruments to be inserted via “ports”.
What is laparoscopy used for?
Laparoscopy can be used to investigate the cause for problems such as chronic pelvic pain as well as to undertake almost any gynaecological operation.
Laparoscopy as an investigative tool:
- Investigation for chronic pelvic pain: Laparoscopy is the gold-standard approach for thoroughly evaluating the pelvis when a cause for pain is being sought. It allows the identification of conditions such as endometriosis and pelvic adhesions that may not show up with ultrasound scanning or other imaging tests like CT or MRI.
- Assessment of infertility and tubal patency: Laparoscopy provides the most comprehensive approach for systematically assessing the pelvis and evaluating tubal patency in cases of infertility.
Laparoscopy as a treatment tool:
- Endometriosis: Endometriotic deposits can be cut away using fine scissors or they can be burnt using electrical energy known as diathermy.
- Adhesions: Scarring brought about by endometriosis or previous pelvic infection can be broken down (referred to as adhesiolysis) using laparoscopy.
- Ovarian cysts: Most forms of ovarian cysts can be removed using laparoscopy.
- Myomectomy: This refers to the removal of fibroids from the womb.
- Hysterectomy: The womb can be removed using laparoscopy, for instance, in women with very heavy periods who have completed their family.
- Oophorectomy: Either one or both ovaries can be removed.
- Salpingo-oophorectomy: Removal of ovaries in addition to the Fallopian tubes can be performed by laparoscopy. One instance in which salpingo-oophorectomy may be advised is in women who carry a mutation in the BRCA1/2 gene since this increases the risk of developing ovarian cancer.
- Ectopic pregnancy: This is a pregnancy located outside of the womb, most often in the Fallopian tube. These pregnancies are very risky since they can cause heavy internal bleeding and tubal rupture. Laparoscopy can be used to either remove the tube with the pregnancy inside it or sometimes, if it is feasible, to remove only the pregnancy.
- Tubal surgery: Laparoscopy can be used to correct blocked tubes or to remove tubes that are swollen and too badly damaged to be repaired.
What are the benefits of laparoscopy and how long will it take to recover?
Laparoscopy offers major cosmetic benefits since much smaller cuts leave much smaller scars. Smaller cuts also result in less post-operative pain and faster recovery and return to normal activity following surgery. In many cases, patients can return home on the same day of surgery thereby dramatically reducing the length of hospital stay.
For simple operations, recovery and return to normal activity usually occurs within 1-2 weeks. For more extensive operations, recovery may take two weeks or more.
It is important to note, however, that not all cases are suitable for laparoscopy and in some instances, it is necessary to undertake open surgery.
Are there any risks associated with laparoscopy?
Laparoscopy is a very safe technique overall. However, as with any operation involving cuts in the tummy, there are risks of bleeding, infection and causing damage to structures such as bowel or bladder. When energy sources such as electricity (known as electrocautery) are used in the tummy during the operation, it is also possible for nearby structures to be inadvertently injured by the heat that is generated. Some of the gas used to inflate the tummy during laparoscopy often remains in the tummy for a short time afterwards and may cause temporary pain in the tips of the shoulders.
Who should perform my laparoscopy?
As with any form of surgery, laparoscopy should only be performed by fully trained specialists. Prof Homer trained and worked for 7 years at one of the UK’s leading laparoscopic centres, University College London Hospitals. He has been accredited (CREI) to perform highly specialised laparoscopic procedures in Reproductive Endocrinology and Infertility.