According to Dr. Usha B.R, Consultant Obstetrics and Gynecology-Apollo Cradle Koramangala, Laparoscopy is a procedure where the abdominal cavity is visualised through small incisions (5mm) made over abdomen. Almost all the Gynaec surgeries can be done through these small incisions. Laparoscopy could be done for diagnostic purposes for unexplained Infertility, to check for tubal patency, for chronic pelvic pain, to take biopsies, to rule out mild endometriosis, and to look for other intra-abdominal pathologies. Many surgeries could be done laparoscopically like Hysterectomy (uterus removal), Myomectomy (fibroid removal), Ovarian Cystectomy (removal of cyst), Salpingectomy (fallopian tube removal). Some of these could be emergencies also like ruptured ectopic pregnancy where the pregnancy sac is in the tube and the tube gets ruptured and also Ovarian torsion where the ovary with or without tube torts on its own pedicle and loses blood supply resulting in severe pain abdomen. All these emergencies usually occur in young ladies who had to undergo open surgeries earlier but now can be managed laparoscopically.
Hysteroscopy is a procedure to visualise the interior of uterus or the endometrial cavity through a scope placed through the vagina and cervix. Diagnostic hysteroscopy is done to visualise the cavity prior to IVF, to take biopsy. Lot of procedures can be done under visualisation like polyp removal, fibroid removal, embedded Cu-T removal, septal resection.
Many surgeries are done using both the techniques of laparoscopy and hysteroscopy like tubal cannulation (removal of block in fallopian tubes) and septal resection.There are many advantages of these minimally invasive surgeries including reduced blood loss during surgery, reduced post-operative pain, reduced adhesions, reduced infections, faster recovery, cosmetically better as there are no big scars, reduced hospital stay. Many of these surgeries are done as day care where the patient is sent back home the same day. Most of the other bigger surgeries would mean a 2 day stay in the hospital. Robotic surgery is an advancement of the laparoscopic surgery, is costlier and is better utilised for complicated cases.
From the Surgeon’s point of view, it would mean a longer learning curve, longer duration of surgery in certain cases but better postoperative results. Like any other surgery, minimally invasive surgery also carries certain risks due to the procedure including risks to the adjacent organs and risks of anaesthesia etc. But all these can be minimised when the surgery is done in a good set up with a good experienced surgeon following all the patient safety norms.
FIBROID (Advantages of laparoscopic Myomectomy)
It is the most common benign or non-cancerous tumour of uterus. It is seen in upto 30-35% of women in the reproductive age group of 15 to 50 yrs. It is a smooth muscle tumour which is totally estrogen hormone dependent. So, it is seen only in the years where the lady has estrogen, i.e. between 15 to 50 yrs. It is a slowing growing tumors, usually not seen before puberty and usually shrinks after menopause. Its size could be as small as pea to as big as a football occupying the whole of abdomen.
These tumours can be silent to be incidentally picked up on ultrasound or could cause symptoms. Fibroids can trouble patients causing heavy menstrual flow, pain during menses, low back ache, heaviness or mass in the abdomen, sub fertility or Infertility, early pregnancy losses or premature delivery. When the fibroid is very big, it can press on the bladder in front causing stasis of urine, incomplete emptying of bladder, repeated urinary infections. It can also press on the bowel behind causing constipation, incomplete emptying etc.
Causes of fibroid can be early menarche, late menopause, obesity, late conception or could also be hereditary.
A good transvaginal ultrasound is the best modality to diagnose fibroids. 3D ultrasound could be used to accurately map the fibroids. Fibroids require treatment or intervention only if they are symptomatic or if they are large enough. If they are big, they may grow further and have the risk of conversion to cancer (sarcoma) and hence Surgery is indicated. The risk of conversion is 0.5 to 1%. Smaller fibroids causing problems could be managed medically. Uterine artery embolization is another non-invasive modality of treatment where the blood vessel feeding the uterus is specifically blocked and so the fibroids shrink. Surgery in the form of myomectomy (fibroid removal) can be done laparoscopically (keyhole surgery) or hysteroscopically depending on the location of fibroid. These minimally invasive surgeries would mean reduced blood loss during surgery, reduced postoperative pain, reduced adhesions, reduced infections, faster recovery, cosmetically better as there are no big scars, and reduced hospital stay.