Gynecologic Laparoscopy

Gynecologic Laparoscopy

Laparoscopy is a surgical procedure which involves operating inside the abdomen through small cuts made in the skin about 0.5-1cm each. The advantages of laparoscopic surgery include:

  • Virtually painless procedure since the cuts are extremely small
  • Cosmetic benefits since the tiny cuts in the skin become almost invisible after a few months
  • Good magnification through the zoomed in view of the endoscope and good lighting allows great vision of deep areas of the abdomen
  • Lesser post-operative complication such as pain, infection & hernia through the cuts in the abdomen
  • Less chances of various organs sticking to each other following surgery (adhesions)
The indications and the surgeries that can be performed through laparoscopy include:

Infertility evaluation and treatment: Laparoscopy done in patients who are unable to get pregnant can reveal pathology such as adhesions due to infection (tuberculosis, PID etc), endometriosis, fibroids, ovarian cysts, etc. These problems can also be tackled by laparoscopy.

Uterine Fibroids & Adenomyomas: Uterine fibroids are tumors of the uterus and a cause of abnormal menstrual bleeding, pain and sometimes infertility. Adenomyosis & adenomyomas are localized ingrowth of the endometrium giving rise to excessive menstrual bleeding and pain. These problems can be tackled by excising the tumors and suturing the uterus through laparoscopy.

Endometriosis: Endometriosis is a common problem involving implantation and growth of the uterine lining (endometrium) on the organs inside the abdomen such as bowel, ovaries, bladder etc. These can give rise to severe pain, infertility and obstruction of the bowel and ureter. The lesions can be excised and burnt by laparoscopy which is the gold standard for treatment of endometriosis.

Laparoscopic Hysterectomy: Laparoscopic hysterectomy is considered in women with abnormal uterine bleeding, fibroids, endometriosis, pelvic tumors etc where other medical and conservative therapies have failed and where vaginal hysterectomy is not possible. The surgery is performed through 2-3 small 0.5-1cm cuts in the skin. Hence, it is painless and asociated with quick recovery of the woman.

Ovarian Cystectomy & Oophorectomy: laparoscopy is the ideal way to manage benign ovarian cysts by removing the cyst (ovarian cystectomy)or the ovary (oophorectomy). Early stage ovarian cancer and suspected ovarian malignancy can also be tackled by laparoscopy with adequate precautions.

Pelvic Organ Prolapse: Pelvic organ prolapse occurs when the vagina or the the uterus and cervix protrude out through the vaginal opening (introitus). This can cause symptoms such as heaviness, urinary retention, repeated urinary infection & incomplete passage of stools. Apart from vaginal surgery, the prolapse can also be repaired via laparoscopy by using a mesh to pull up the uterus or vagina and fix it to a firm structure in the pelvis (usually sacrum). This procedure is called laparoscopic sacral colpopexy or hysteropexy.

Tuboplasty: Tuboplasty involves joining cut or damaged ends of the Fallopian tube to restore the reasonably normal length and patency of the Fallopian tube to allow for a natural pregnancy. This is done if a smal middle portion of the Falopian tube is blocked such as after a tubal sterilization. This can be done by laparoscopy with excellent results.

Cervical & Endometrial Cancers: These are the most common of all cancers in a woman. These supramajor operations can be done by laparosopy with excellent recovery and low morbidity.

Ectopic Pregnancy: Ectopic pregnancy is a pregnancy occuring outside the uterine cavity usually in the Fallopian tube and rarely in other organs such as the ovary. These pregnancies can lead to massive hemorrhage inside the abdomen. Laparoscopy is the procedure of choice for this problem.

Management of Pelvic Inflammatory Disease: Laproscopy is the ideal method for evaluating and treating pelvic infection. Treatment involves release of adhesions, drainage of pus & removal of infected tubes and ovaries.

Unusual Surgeries: These include tackling of post-operative bleeding, management of uterine inversion, suturing of cesarean section scar dehiscence & repair of a double uterus (unification of a bicornuate or didelphic uterus).

Today, all over the world, laparoscopy has become the gold standard and benchmark for treatment of majority of gynecological problems safely and effectively.