Laparoscopy: A preferred choice for Gynecological Procedures

Laparoscopy is a minimally invasive, key-hole surgical procedure that is performed through a single or multiple tiny incisions, rather than an ugly-looking larger, single incision. Speedy recovery, minimal pain, scarring and a better outcome are some of the benefits which make laparoscopy the gold standard method for diagnosis and treatment of a wide range of gynaecological pathological conditions including: 

• Chronic pelvic pain

• abnormal uterine bleeding

• Endometriosis

• Fibroid tumours

• prolapse surgery

• Infertility

• Ovarian tumours and cysts removal.

• Tubal ligation

• tubal reconstruction

• fertility enhancing surgeries.

• Repeated pregnancy loss

• uterine congenital malformation.

• Ectopic pregnancy treatment.

• Cancer of the uterus, ovary etc

Benefits of Gynecologic Laparoscopy

A gynaecological laparoscopy is a procedure that helps a doctor examine your uterus, fallopian tubes and ovaries. Compared to open surgery, gynecologic laparoscopic surgery offers several advantages including: 

• Less-invasive procedure

• Smaller incisions in the lower abdomen, no organ exposure results in lower chances of infection.

• Minimal scarring resulting in improved cosmesis.

• Reduced post-operative pain needing fewer medicines.

• Shorter hospital stays.

• Less blood loss reduces the need for blood transfusion and related complications.

• Quicker return to normal life and to work.

Tools used

All laparoscopic procedures make use of some basic tools including:

• Laparoscope: A long, thin tube made of high-quality stainless steel which is fitted with a high-intensity, cold light source and an HD video camera at the tip.  

• High-resolution computer to capture images transmitted by the laparoscope. 

• Endoflater: Gases such as carbon dioxide are used to inflate the abdominal cavity and enlarge the operating field.

• ESU: Electrosurgical unit to achieve bloodless surgery 

• 3D CAMERA: for better depth perception and precise surgery.

• WORKING INSTRUMENT:  5 mm thin elongated hand instruments to achieve perfect surgery.

• Recording facility for documentation

Laparoscopic Gynaecological Procedures:

Laparoscopic surgery is used to treat several gynaecological conditions including:

Myomectomy

Myomectomy is a surgical procedure that involves the removal of the symptom-causing fibroids that appear in the uterus. Your gynaecologist in Delhi may recommend myomectomy if these fibroids cause:

• Heavy menstrual bleeding

• pressure symptoms

• Chronic pelvic pain

• Pregnancy complications include repeated pregnancy loss, premature labour, foetal growth complications, etc. 

A myomectomy can be done using one of two surgical approaches:

• Laparoscopic Myomectomy: This procedure involves smaller incisions around your belly button. Various instruments including a laparoscope are inserted through these incisions to remove the uterine fibroids.

• Robotic Myomectomy: While the procedure is an advanced laparoscopic myomectomy, robotic arms are used to remove the uterine fibroids. 

Laparoscopic Hysterectomy

Laparoscopic hysterectomy is used to remove the uterus (womb) and cervix via multiple small incisions on the abdomen or pelvis. Sometimes ovaries and fallopian tubes are also removed. 

Your gynaecologist may recommend a hysterectomy if you are suffering from:

• Fibroids (non-cancerous/benign tumours in the uterus)

• Endometriosis (uterine lining-like growth outside the uterus)

• Adenomyosis

• Chronic pelvic pain

• Abnormal bleeding

• Uterus, cervix, or ovarian cancer

• Uterus prolapse etc

Depending on the condition of the patient, a hysterectomy can be:

• Total Hysterectomy: This procedure is used to remove the entire uterus, including the cervix. 

• Partial Hysterectomy: Only a part of your uterus is removed leaving your cervix intact.

• Hysterectomy and Salpingo-oophorectomy: In this procedure, the uterus along with one or both ovaries and fallopian tubes are removed.

A Hysterectomy can be done using one of the surgical approaches:

• Vaginal Hysterectomy: In this procedure, the surgeon will make a small incision inside your vagina to remove your uterus. There are no external cuts or visible scars.  

• Laparoscopic Hysterectomy: In this procedure, the surgeon will make three to four small incisions in the abdomen. A laparoscope is inserted and your uterus is cut into smaller pieces and the pieces are removed one by one. 

Tubal Ligation or Sterilisation by Laparoscopy

Your gynaecologist may recommend tubal ligation or sterilisation if you no longer want to conceive or have children. Sterilisation by laparoscopy is the most convenient and safe form of permanent birth control. The fallopian tubes are removed or obstructed to prevent future pregnancies. A small incision is made near the bellybutton and the fallopian tubes are sealed by:

• Electrocoagulation (electric current is passed)

• A band or a clip is placed over the fallopian tubes

Sacrocolpopexy

If you feel heaviness and discomfort around your lower tummy, or if you feel like something is coming down into your vagina, it may be due to prolapsed pelvic organ.   Sacrocolpopexy is a procedure that is performed laparoscopically to repair the prolapse. A surgical mesh is attached to the vagina to support the pelvic organs. 

Adnexal surgery 

• If you are suffering from tumours, infections or cysts in the ovaries or fallopian tubes adnexal surgery is recommended. Ovarian tumours, and cysts are removed laparoscopically. 

• Polycystic ovary syndrome can be treated by drilling small holes using a hot needle or laser in your ovaries. This procedure is called “Ovarian drilling” and the chances of you getting pregnant increase after this procedure. 

• Lap Surgery for Ectopic pregnancy: Tubal opening surgery or unblocking your fallopian tubes is performed laparoscopically to increase your chances of pregnancy. 

Laparoscopy in Cancer Diagnosis and Treatment

Laparoscopy is used successfully to diagnose (staging) and to remove a cancerous growth in the pelvis or abdomen which includes: 

• Uterine cancer or Endometrial cancer: Uterus, cervix, fallopian tubes, ovaries, etc. are resectioned laparoscopically. 

• Cervical cancer: Treatment includes laparoscopic radical hysterectomy and lymphadenectomy

• Ovarian cancer: Laparoscopy is performed for staging or diagnosis of ovarian cancer, and also to check for the possible recurrence of the disease.

Frequently Asked Questions

1. What is the difference between a laparotomy and a laparoscopic myomectomy?

In laparotomy which is also known as abdominal myomectomy, the uterine fibroids are removed through an open or bigger abdominal incision while in laparoscopic myomectomy several small incisions are made to remove the fibroids. This procedure is least invasive and recovery is faster compared to laparotomy. 

2. Is the outcome of robotic surgery better compared to traditional laparoscopy?

Robotic surgery may take a longer time and is a bit expensive compared to traditional laparoscopy, but otherwise, most of the outcome of the surgery is the same.

3. How does laparoscopy help in inducing pregnancy?

Laparoscopy helps in the diagnosis and treatment of several gynecologic conditions that induce pregnancy and improve assisted reproductive technology outcomes. For example, treatment of endometriosis, congenital malformation, ovarian cysts, polycystic ovaries, or unblocking your fallopian tubes laparoscopically can increase your chances of pregnancy. Visit a laparoscopic surgery hospital today for the treatment.

4. What is the best way to treat adenomyosis?

Adenomyosis can be diagnosed and treated by performing a laparoscopic adenoidectomy or hysterectomy (a procedure to remove the uterus)

5. What are congenital uterine anomalies?

Congenital uterine anomalies (CUAs) are malformations of the uterus or the womb during the development of the baby in the mother’s womb​​​​​​.

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