The World of Gynecologic Endoscopy

The World of Gynecologic Endoscopy

Endoscopy means “looking inside”. Gynecologic (study of the female body) surgery has been revolutionized by the advent of endoscopy in the last four decades. Starting with simple surgeries like tubal sterilization which changed the face of the family planning program in India we have progressed to performing complex surgeries such as hysterectomy and surgery for gynecological cancers.

Endoscopy involves placing a small telescope into the human body through tiny incisions (3-5mm). The telescope can be placed into the abdomen via small tubes called ports (laparoscopy) or inside the uterus through the mouth of the uterus or cervix (hysteroscopy).

Various fine and delicate instruments are available through which complicated surgeries can be performed inside the abdomen or the uterus. In fact, endoscopic surgery has become the gold standard of surgery today. Since most of these instruments are being manufactured locally, the cost of endoscopy has also reduced significantly since its advent in the eighties.

However, endoscopy involves significant amount of instrumentation. This requires the doctor to acquire special skills and expertise in the subject.

Laparoscopy can be performed for the following indications:

  1. Infertility: Infertility is the inability to conceive. Laparoscopy is performed in women with long standing infertility or those showing some pathology on investigation (uterine fibroids or endometriosis)
  2. Abnormal uterine bleeding: Abnormal uterine bleeding is heavy or prolonged bleeding during menses. This can due to hormonal problems, uterine pathology such as fibroids or adenomyosis, or ovarian tumors. This can be treated by various laparoscopic surgeries such as hysterectomy, removal or fibroids or excision of the ovarian tumors.
  3. Chronic pelvic pain: Chronic pelvic pain can be due to pathology such as endometriosis, pelvic adhesions, tumors or pelvic congestion. These can be managed laparoscopically by surgeries such as excision of endometriosis, adhesiolysis, presacral neurectomy or uterine nerve ablation.
  4. Pelvic organ prolapse: prolapse means descent of the uterus and its adjacent structures through the vagina due to weakening of its supports. These problems can be corrected laparoscopically by surgeries such as sacral colpopexy, sacral colpohysteropexy, culdoplasty and uterosacral ligament plication.
  5. Ectopic pregnancy: Ectopic pregnancy is a pregnancy implanted outside the uterus usually in the Fallopian tube or the ovary. Laparoscopic surgery involves removal or the affected organ or excision of the ectopic pregnancy.
  6. Tuboplasty: This involves joining of healthy segments of the Fallopian tube laparoscopically. This is most effective for reversal of tubal sterilization.
  7. Gynecological cancers: Laparoscopy is the surgery of choice for early stage endometrial and cervical cancers.
  8. Other procedures: These include correction of uterine inversion, unusual surgeries for pelvic organ prolapse & stress urinary incontinence, abdominal circlage during pregnancy and unification of a bicornuate uterus.

Hysteroscopy can be performed for the following indication:

  1. Infertility and recurrent pregnancy loss: abnormalities inside the uterus such as a septum, T-shaped cavity, fibroids and polyps can contribute to recurrent pregnancy loss and, at times, infertility. These can be corrected by hysteroscopic surgery
  2. Abnormal uterine bleeding: Heavy, irregular or prolonged bleeding can be treated with surgeries such as hysteroscopic myomectomy, polypectomy and resection of the endometrium.
  3. Removal of foreign bodies: This includes removal of missing copper T and retained fetal bones.
  4. Hysteroscopic tubal cannulation: Fallopian tubes blocked because of spasm or mucus plugs can be successfully opened by passing a guide wire and a catheter via hysteroscopy.

Advantages of endoscopy include:

  1. Significantly reduced pain
  2. Smaller and more cosmetic incisions
  3. Reduced risks of hernias and abdominal adhesions (organs sticking to one another following surgery leading to pain, intestinal obstruction and infertility)