A: Laparoscopic surgery, also known as laparoscopy, is a type of operation which uses a laparoscope and other small instruments to perform internal surgical procedures. During a laparoscopy, the laparoscope and other small tools are inserted into the patient’s body through two to four small incisions in the abdomen, each five to ten millimeters in length. Through these small incisions, it is then possible to operate on the internal organs in the abdomen or pelvic area, by looking at the images in the area of operation via a video monitor connected to the laparoscope. So, when we talk about gynecologic laparoscopy, we are referring to a type of laparoscopy which is used to treat a range of conditions affecting the internal organs in the female pelvic cavity. This includes the uterus, ovaries, fallopian tubes and other nearby organs.
A: Laparoscopy is a type of surgery that is performed using small incisions. When the incisions are small, the patient will experience significantly less pain and bleeding after the operation than with traditional open surgery, which means that the patient can recover quickly and go back to work and other normal activities sooner. Have you ever heard of abdominal scar tissue? Every type of open abdominal surgery can result in scar tissue in the abdomen, and this scar tissue is itself a cause of chronic abdominal pain amongst women. Some women may experience this chronic pain for years; additionally, abdominal scar tissue can cause infertility. Laparoscopic surgery, however, causes very little scar tissue in the abdomen, or in some cases none at all. This means that after the operation, the patient will experience almost no chronic pain caused by abdominal scar tissue. Additionally, during the operation, we use a laparoscope with magnification power, and sometimes we also use a 3D laparoscope. Using this equipment allows the doctor to see the operation in significantly more detail than with only the naked eye, meaning we can execute the operation with a higher level of precision. Finally, and crucially for all the women and girls today, is the issue of beauty. Laparoscopic surgery causes minimal scarring and only on the surface of the abdomen, while some patients who do not scar easily may recover with no scars at all. Possibly, no one will even be able to tell that the patient has undergone surgery.
A: The conditions which we most often treat include uterine fibroids, where we surgically remove the patient’s tumor or remove the uterus completely. We also treat ovarian cysts, as well as chocolate cysts, which are commonly found among young girls or working age women. In both cases, we operate either to remove the cyst(s) or remove the fallopian tubes, together with ovaries, entirely. Then there are fallopian tube disorders, such as ectopic pregnancy, abdominal scar tissue, and women who have chronic pelvic pain but do not know the cause of it – laparoscopy treats these conditions. At present, gynecological laparoscopy has developed significantly, and we can now say that laparoscopy can be used instead of open surgery for almost every gynecological condition which requires surgery, including female cancers, such as cervical cancer and endometrial cancer.
A: Some patients may have a gynecological condition, but may not experience any symptoms. In such cases, the condition can be identified during an annual physical examination that includes a pelvic examination and an ultrasound scan, making annual internal examinations extremely important. Patients with uterine fibroids will experience symptoms such as abnormal periods or severe pain during menstruation. Among these patients, some will experience pressure on the bladder, which causes frequent urination, and some patients may experience pressure on the rectum which also causes pain, injury to the coccyx and constipation. Some patients experience abdominal distention until a mass of fibroids can be felt through the skin – a symptom that some patients may mistake for weight gain. Some patients may even go to consult their doctor with concerns about infertility and discover that they have an uterine fibroid. Additionally, for those patients who have ovarian cysts, they may go to see a doctor with concerns about increased or recurrent period pain, or sudden pain due to the rupturing of cysts or ovarian torsion. Some patients may experience chronic pelvic pain, but not know the cause of it. Consequently, women who experience symptoms such as abnormal periods, severe menstruation pain, noticeable abdominal distention, sudden pelvic pain, or longstanding chronic pelvic pain but do not know why, or patients who have urinary symptoms or abnormal stools, should undergo a gynecological screening to be sure that none of the above conditions are present.
A: Yes, but it may not always be two to four wounds. Originally gynecological laparoscopy required two to four incisions to be made on the abdomen, but today surgeons can perform laparoscopy that leaves even fewer scars. Single port laparoscopic surgery reduces the number of scars to just one scar on the navel, right on the belly button. The advantage of this technique is that when the wound from the incision heals, the scar will not be visible at all, as it will be rolled up inside and concealed by the belly button.
A: Single-port laparoscopic surgery requires special tools and surgeons with particular expertise. We are continuously using this technique, and expect that in the future it will be used instead of multiple-port laparoscopic surgery for almost all conditions; but even so, this does not mean that every patient will be eligible for single-port laparoscopic surgery; ultimately it depends on the judgment of the surgeon.
A: We have been performing this type of surgery for three to four years. It’s called natural orifice transluminal endoscopic surgery (NOTES), and it leaves no scarring on the skin whatsoever. This type of laparoscopic surgery is performed through one of the body’s natural orifices, particularly the birth canal. The advantages of this type of surgery are twofold: first, there is no scarring on the surface of the abdomen; and secondly, there is even less pain after the surgery than all other kinds of laparoscopy. At present, the conditions that we are able to treat with NOTES include: cyst removal, fallopian tube and ovary (hysterectomy) – without scarring. However, NOTES cannot yet be performed on all patients. The doctor will conduct a comprehensive assessment of each patient and the doctor must also have significant expertise in this area of surgery.
A: In truth, all types of surgery carry certain risks, such as excessive bleeding or damage to nearby organs, for example, the bladder, ureter or the large intestine. But, if the patient is properly assessed before surgery, and if the team of surgeons has the required expertise, the associated risks of laparoscopic surgery are no different from those associated with open surgery.
|Minimally Invasive Surgery (MIS) – New standard of care for surgical procedures|
Faculty of Medicine Siriraj Hospital, Mahidol University , 1999