Laparoscopy and Histeroscopy
Most gynaecologic procedures routinely performed today can be carried out by minimally invasive techniques (keyhole surgeries) such as laparoscopy and hysteroscopy. These treatment options are of remarkable importance among the health-care services provided in developed countries. The significance of these procedures lie in that neither the operation nor post-operation recuperation are physically demanding for the patient.
Advantages of endoscopic procedures:
- The average operation time for these procedures is similar -or shorter- than that of the equivalent open surgery
- Post-operative complication rates and adhesion formation however are much lower due to small (half inch) incisions made on the abdomen and extremely delicate manipulations applied within the pelvis
- Post-operative recuperation, hospitalization and full recovery following the procedures are reduced tremendously compared to these characteristic of open surgery. Average hospitalization after endoscopy is not more than 2-3 days, while that after classic open surgery is 8 days. Recovery at home is usually 1-2 weeks following endoscopy, whereas it can be as long as 4-6 weeks for patients undergoing open surgery
Nowadays, in the midst of an accelerated pace of life and competitive workforce environment, most people consider the time away from work due to an illness a significant factor.
Gynaecological endoscopy meets these socio-economic criteria. Disadvantages of endoscopy lie in the high costs of instrumentation needed, therefore only few centres can afford to maintain a full set of OR instruments including laser to be able to perform across the board laparoscopy and hysteroscopy.
Endoscopic procedures are performed in narcosis following a careful examination and aesthetic consultation. Blood tests, X-ray, ECG and other tests if needed are taken. The method of narcosis is determined by the anaesthesiologist based on the type and predicted length of the procedure and is always consulted with the patient. All procedure types require certain preparation, which are done upon hospitalization.
When is laparoscopy recommended?
Laparoscopy is recommended for cases of pelvic pain, dubious test results, infertility, suspected ectopic pregnancy and for the diagnosis of other gynaecological disorders. If during the diagnostic procedure it is revealed that some treatment is needed to resolve the situation then it is possible to switch to an operative approach in one sitting instead of undergoing repeated operation and further anaesthesia.
Laparoscopy can be used to treat:
- uterine fibroids and positional abnormalities of the uterus
- certain disorders of the fallopian tubes and the ovaries
- various forms of endometriosis that cause intense pelvic pain as well as infertility
- certain cases of congenital disorder
- infertility related to adhesions resultant from pelvic inflammation
- certain urinary disorders
There are different options to perform laparoscopy (prior to the treatment the options are always consulted with the patient):
- During classic laparoscopy, the abdominal cavity is distended by CO2 gas through a special needle in order to achieve better visualization of the inside. Then the laparoscope is inserted into the abdomen through a small (approximately 1 cm long) umbilical (belly button) incision.
- During open insertion -usually if the patient had previous surgery- a small (2-3 cm long) incision is made below the belly button and the scope as well as the gas is entered through this. This method is used when the medical history of the patient entails periumbilical adhesions therefore complications in entering the abdomen.
- The abdominal and pelvic cavities are sometimes distended through the vagina and the scope is also inserted vaginally.
The technique of choice is always consulted with the patient prior to the procedure.
Frequently during laparoscopy the uterus is sounded to move the uterus away in order to improve visualization of the pelvis. When laparoscopy is performed for indications of infertility sounding is also used to enter ink into the uterine cavity and the tubes in order to determine their patency. This procedure is called chromopertubation.
Laparoscopy is usually performed under general anaesthesia.