In gynaecology, laparoscopy is a surgical technique where a telescope is inserted into the tummy for diagnosis and treatment of diseases related to the female reproductive organs.
With advancements in instruments and equipment like 3D and 4D cameras, almost all gynecological surgeries are being performed with the help of Laparoscopy.
In different parts of the World, people call Laparoscopic surgery as Keyhole surgery or Minimally Invasive Surgery or Buttonhole surgery.
1. Minimally Invasive:
Laparoscopy involves making small incisions, typically less than an inch, compared to the larger incisions required for open surgery. This results in less trauma to surrounding tissues and muscles.
2. Operation with more precision because of Improved Visualization during surgery :
The laparoscope provides a magnified view of the surgical area, allowing surgeons to see details with greater clarity and precision.
3. Reduced Pain:
The smaller incisions and less tissue trauma lead to significantly less post-operative pain. Patients often require less pain medication compared to open surgery.
4. Lesser adhesion formation compared with the conventional operation technique
5. Reduced Risk of Infection:
Smaller incisions reduce the risk of wound infections and other complications associated with open surgery.
6. Faster Recovery:
Patients undergoing laparoscopic surgery typically experience a quicker recovery and return to their normal activities sooner. This is due to the reduced trauma and pain, allowing for earlier mobilization.
7. Shorter Hospital Stay:
Due to the faster recovery and reduced pain, patients may be discharged from the hospital sooner, sometimes even on the same day or the next day after surgery.
8. Smaller Scars:
The small incisions result in minimal scarring, which is often barely noticeable after the wound has healed.
9. Lower Blood Loss:
Laparoscopic surgery often results in less blood loss compared to Conventional or open surgery.
10. Reduced Internal Scarring:
Laparoscopic surgery can minimize internal scarring compared to open procedures.
1. Diagnostic:
In this modern era of medical sciences, with the advancement of imaging techniques like 3D, 4D Ultrasonography, MRI, CT Scan, there is a very minimal role of diagnostic Laparoscopy.
However, diagnostic Laparoscopy can be a gold standard modality not only for diagnosis but also curative in the same setting of rare conditions like chronic pelvic pain, Atypical Endometriosis.
Confirmation of blocked fallopian tubes and opening of the tubes with the combined use of Hysteroscopy to Restore Fertility
2. Operative Laparoscopy:
Some common conditions which can be surgically treated by laparoscopy include:
Hysterectomy: Removal of the Uterus of any size is possible through small holes with innumerable advantages
Laparoscopic Myomectomy: Large, multiple, complex Fibroids located at any part of the Uterus or other areas in the tummy are removed by the technique called laparoscopic Myomectomy through Small Holes with lesser blood loss, faster recovery, and fertility preservation
Endometriosis Excision:
Endometriosis occurs when the cells similar to the Endometrium ( Innermost layer of the Uterus ) are found outside
the uterus at an unnatural position. Endometriosis can affect any organ system from the Brain up to the leg muscles. Often seen over the fallopian tubes, ovaries, and other
surrounding organs in the pelvis, such as the bladder or bowel.
Ovarian Cystectomy:
An ovarian cyst is a fluid-filled sac that develops
in an ovary. Most ovarian cysts are non-cancerous, and some can
cause problems such as pain and irregular bleeding. Sometimes undergo torsion and may require emergency surgery for fixation.
Oophorectomy: Removal of the Ovary through a small hole. Ovarian mass with possible risk of Ovarian Cancer and willing to preserve fertility can be managed by Oophorectomy.
Ectopic Pregnancy:
An ectopic pregnancy is where the
Pregnancy occurs outside the uterus, usually in the fallopian
tube.
The tube may need to be removed.
Laparoscopic cervical cerclage: Diagnosed cases of proven Cervical incompetence ( women with previous second-trimester abortion ) are managed by putting a suture around the cervix via laparoscopy.
Circlage can be done during pregnancy or in between pregnancies ( Interval )
Laparoscopic Isthmocele repair: With the rising incidence of Caesarean Deliveries, the incidence of Isthmocele ( defect in healing ) is on the rise. This may cause painful menstrual periods, Prolonged menstruation, Pelvic pain, Painful Intercourse, and Infertility.
Laparoscopic Isthmocele repair surgery gives excellent results in relieving the symptoms.
Vaginoplasty: Creation of a new vagina in young girls with an absent vagina since birth due to a congenital anomaly.
Pelvic Inflammatory Disease:
Pelvic inflammatory disease (PID)
It is an infection of the womb and/or fallopian tubes.
Hydrosalphynx ( Fluid acculturation inside the fallopian tubes )
Adhesions:
Adhesions are areas of ‘scar tissue’ which form when
pelvic or other internal organs stick together, which can happen
after infection, surgery, or inflammation.
Previously, Laparoscopy was contraindicated in conditions like Obesity, Multiple previous open operation scars, associated comorbid conditions of heart or lungs, ruptured ectopic with haemorrhagic shock, Intraabdominal adhesions, and pregnancy
But now Laproscopy is a preferred modality for the management during such situations,
Procedure of Laparoscopy:
A laparoscopy may also be referred to as keyhole surgery, as is performed through a small incision of 10 mm through which a Telescope attached to a camera is introduced and the magnified image of inside the tummy is displayed on the screen with very well differentiation of tissues.
Special surgical instruments are inserted through two to four 5 mm incisions, and the operation is carried out with the aid of an internal telescope and camera system.
Complications of Laparoscopy:
As there is very minimal risk of complications during laparoscopy, sometimes complications arise, such as –
Postoperative pain, including abdominal and shoulder tip pain.
Urinary infection, retention, and/or frequency.
Wound infection, bruising, and delayed wound healing.
After laparoscopic surgery, patients may follow certain things for faster recovery.
These may include –
Proper posture: Keeping spine straight while sitting and standing is very important to prevent backache in future which may arise because of faulty posture and not Laparoscopy
Weight lifting: Avoid heavy weight lifting for 6 weeks after surgery but routine household activities are encouraged for the faster recovery
Climbing stairs & Walking: No restrictions for walking, climbing stairs and sitting on chairs.
Exercise: The day after the operation or whenever feels comfortable, the patient can go for a short 10 to15 15-minute walk in the morning and the evening.
Increase the activity levels quite rapidly over the first week.
Women will be back to their previous activity levels by the second week.
Diet: A well-balanced, nutritious diet with a high fibre content is
essential to avoid constipation. No limitation to any kind of food item. Regular dietary habits are always encouraged.
Bowels may take some time to return to normal after the operation, and the patient may need to take laxatives after consulting to Doctor.
One should include at least 5 portions of fruit and vegetables per day
day. One should have at least 2 to 3 litres of water per day.
Yoga And Meditation: Yoga and meditation help in keeping the mind and body in a sound state, hence helping in better and faster recovery.
Specific advice given related to that particular operation needs to be followed carefully for the optimum results after surgery.
Consultant Gynecologist with specialisation in laparoscopic and robotic-assisted surgeries.
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