Laparoscopy (Key Hole Surgery) in Gynaecology

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The use of laparoscopy in gynecological surgical procedures has increased in recent years as more studies have been presented that support the safety of this approach.

By Dr Noorul Ayain

Laparoscopic surgery, also called as minimally invasive surgery (MIS), or keyhole surgery, is a modern surgical technique in which operations are performed through small incisions (usually 0.5″“1.5 cm) in the body. Laparoscopes are rigid endoscopes with fibre optic cable system connected to a “cold” light source, with a digital camera at one end. Access to abdomen or pelvis is gained through a small incision guided by a cannula or trocar. Abdomen is inflated with carbon dioxide gas which is non inflammable and easily absorbed and excreted by human tissues.
Many procedures can be performed laparoscopically like removal of gall bladder or infected appendix, repair of hernias, uterus with fibroids, only fibroid removal (myomectomy), ovarian or tubal masses, management of infertility etc. The use of laparoscopy in gynecological surgical procedures has increased in recent years as more studies have been presented that support the safety and efficacy of this approach. In particular, the advantages of laparoscopically assisted vaginal hysterectomy (LAVH) over conventional laparotomy have been well documented. These advantages include shorter hospital stay, shorter recovery time, reduced hospital charges, and comparable if not fewer complications like bleeding, infection etc, while avoiding a large laparotomy wound. Similar advantages have occurred with laparoscopic management of adnexal (ovarian and tubal) masses that appear benign on ultrasound. With appropriate preoperative evaluation, laparoscopy should replace laparotomy in the management of gynaecological problems. The major factor restricting its use is cost. All equipment must be imported, making it particularly expensive. Financial limitations are a particular obstacle in privately owned hospitals. Patient education and expectations based on cultural tradition continue to be another major obstacle. Patients are reluctant to consent to laparoscopic surgery not only because it is new to them, but also because they often do not understand the benefits. Disadvantages of laparoscopy from the surgeons perspective are restricted range of movement, long learning curve, poor depth
perception. But all of these can be overcome by experience.
Risks are similar to open surgery like bleeding, infection, injury to other internal organs. These have to be promptly recognised and tackled with appropriately. Patient education and awareness are important steps in order to allay anxiety and remove the myths associated with laparoscopy. The best person to render awareness to the general population with be their personal or family doctors.
(Dr. Noorul Ayain, MD, is a consultant Obstetrician, Gynaecologist and Infertility Specialist at Primecare Hospital, Frazer Town, Bangalore)