Laparoscopic gynaecological surgery - Dr Alastair Morris
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Laparoscopic gynaecological surgery

Laparoscopic gynaecological surgery

Laparoscopy currently plays a central role in the investigation and surgical treatment of many common gynaecological conditions. The key advantages are reduced pain, a shorter hospital stay with faster overall recovery and improved cosmesis.

 

In gynaecology, laparoscopy is often used to investigate pelvic pain, painful periods (dysmenorrhoea), uncomfortable sexual intercourse (dyspareunia) and infertility and to treat numerous conditions including:

 

Ectopic pregnancy
Endometriosis
Ovarian cysts
Female sterilisation
Menorrhagia (heavy periods) when hysterectomy may be performed
Fibroids
Uterine prolpase
Adhesions

 

This is not an exhaustive list and some procedures are more complex than others. The RANZCOG has developed guidelines with respect to the level of training and supervision that an individual gynaecologist needs to be able to safely undertake particular operations. For example, gynaecologists are all expected to be competent to treat an uncomplicated ectopic pregnancy by the end of their training whereas undertaking a laparoscopic hysterectomy is technically much more difficult and requires and additional advanced skill set to be demonstrated in order to be safely offered.

 

A general anaesthetic (GA) is administered and a variable number of small cuts approximately 5-10mm in length are made in the lower abdomen (“tummy”) to allow instruments to be inserted. Additionally, a camera is placed in the umbilicus (“tummy button”) to allow placement of a camera used to visualise the pelvis and abdomen. Up to a total of four ports are routinely used but occasionally more may be needed. Alternatively, a single incision may be used but this requires additional equipment and training. Although many procedures can be performed on a day case basis most require an overnight stay in hospital. A return to normal routine is often achieved within a week.

 

Complications may occur during any operation and this is also true for laparoscopic gynaecological surgery. These include, but are not limited to, anaesthetic complications, abnormal healing / scarring (keloid formation), infection, venous thrombo-ebmbolism, bleeding and accidental damage to other organs such as major blood vessels / bowel and ureter. Unfortunately, these lead to the necessity for a laparotomy (a larger cut in the abdomen) in approximately 0.2% (1 in 500) of procedures.