A laparoscopy is an examination of the pelvis through a telescopic lens inserted through keyhole surgical incisions in the abdomen. It is used to make a diagnosis or to treat a surgical problem.
Most patients can have a laparoscopy performed and their recovery is usually straightforward. Some patients may have higher risks because of their weight, medical history, or complexity of the planned surgery. These patients may not be suitable for laparoscopic surgery at all. A patients risks need to be discussed and referral to a laparoscopic sub specialist should be considered if necessary.
Laparoscopic surgery is performed under a general anaesthetic.
Instruments are inserted through a number of small abdominal incisions.
The abdominal cavity is inflated with gas to create a space in which the pelvic organs can be viewed and the operative procedure performed.
Laparoscopic surgery can be divided into diagnostic and operative laparoscopy.
Diagnostic laparoscopy is commonly performed to identify causes of:
- Pelvic pain.
- Dysmenorrhoea (period pain).
- Visualise the extent of pelvic adhesions (endometriosis or P.I.D.).
- Determine the nature of any pelvic mass.
Laparoscopic photographs are obtained to confirm the distribution and extent of any pelvic pathology. This establishes the patient’s diagnosis and will allow appropriate planning for subsequent treatment.
All general gynaecologists can perform diagnostic laparoscopy, and all can perform routine operative laparoscopy.
Simple operative procedures that are performed include:
- Laparoscopic sterilization.
- Diathermy of minor degrees of endometriosis.
- LUNA procedure (laparoscopic uterosacral nerve ablation) for pelvic pain.
- Division of mild pelvic adhesions.
- Excision of small ovarian cysts.
Complex operative laparoscopy involves more extensive surgery and in turn involves greater risks. These procedures should be performed by sub specialist surgeons who only perform laparoscopic surgery, and who have great skill.
Complex Operative laparoscopy includes:
- Removal of an ectopic pregnancy (salpingectomy).
- Excision of ovarian cysts or the ovary itself.
- Treatment of extensive pelvic adhesions and endometriosis.
- Laparoscopic hysterectomy.
- Oophorectomy etc. – should be referred to a laparoscopic surgeon.
Laparoscopy has the advantage of performing procedures through a number of small incisions in the abdomen rather than a larger incision used for “open” surgery. Some patients may be discharged home on the same day and may have less pain. It is important that all surgery should be precise, anatomically neat and free from any serious complications. The laparoscopic surgical skill of the surgeon should determine the nature and complexity of the laparoscopic procedure being performed.
Laparoscopic surgery, which is performed with skill and is not complicated usually results in faster recovery times. As with all surgery complications can also happen with laparoscopy. Complications can be serious and may include problems such as persistent bleeding, haematomas (collections) and perforation of bowel. These complications can result in prolonged recovery with pelvic scarring and prolonged pelvic pain and may even warrant repeat surgery.
It is important never to confuse patients by terms such as “minimally invasive surgery”. If complex procedures are performed by gynaecologists who do not have the surgical expertise, complications may occur. In these cases referral to a laparoscopy sub specialist is the best choice.
It is wise to ask your doctor about their personal experience in performing more complicated laparoscopic procedures.
It is always important to remember, the general gynaecologist always performs less complicated laparoscopy.
The essence of all surgery is operative skill and precision. Any operation that is considered potentially dangerous and has greater risks should be referred.