Laparoscopic Surgery
What Is Laparoscopy
Laparoscopy is a modern technique used in gynaecological surgery that allows access to the inside of the woman’s abdominal cavity. With this method, it is possible either to identify and diagnose conditions such as endometriosis or adhesions (diagnostic laparoscopy), or to perform surgical procedures to treat problems (operative laparoscopy). Nowadays, the majority of gynaecological surgical procedures are performed laparoscopically by specialised gynaecologists with experience in endoscopic surgery and require specially equipped operating theatres with cutting-edge technology.
In Which Cases Is It Used?
The most common indications for laparoscopic surgery are the following:
● ovarian cysts. In this case, laparoscopic ovarian cyst removal offers definitive, bloodless treatment while protecting the patient’s fertility.
● endometriosis. Laparoscopy allows precise excision or cauterisation of disease lesions.
● ectopic pregnancy. Laparoscopy offers early diagnosis and treatment that reduces morbidity and mortality, while improving fertility rates after surgery.
● tubal opening / tuboplasty. Laparoscopy enables restoration of tubal patency, improving fertility prospects.
● pelvic adhesions. Laparoscopy provides direct visualisation and adhesiolysis with less pain and faster recovery.
● fibroids. Laparoscopic removal of fibroids is the method of choice in most cases, reducing recovery time and the formation of adhesions.
● unexplained infertility. Laparoscopy can identify pathologies not detected by other tests, such as endometriosis or adhesions.
● uterine prolapse. Laparoscopy offers safe and aesthetically pleasing results with minimal burden on the patient.
● hysterectomy. Laparoscopy is used for removal of the uterus, offering a lower risk of complications and faster recovery.
● uterine cancer. Laparoscopic removal of the uterus and lymph nodes is an established method for treating endometrial cancer, reducing intraoperative and postoperative complications.
How To Prepare
Preparation for laparoscopic surgery begins a few days earlier with a preoperative assessment at the clinic, which includes blood tests and a cardiology evaluation, without requiring fasting.
In the days before surgery, emphasis is placed on appropriate bowel preparation, as the bowel should be empty on the day of the operation. For this reason, the patient should avoid consuming vegetables, legumes, and dairy products for 3–4 days.
The day before the operation, taking a laxative to empty the bowel is recommended, and adequate fluid intake is important. Finally, during the last 8 hours prior to surgery, the patient must remain fasting, with no food or liquids.
Procedure
During laparoscopy, which is performed under general anaesthesia, a thin, long camera (laparoscope) is placed into the woman’s abdomen through a small opening of 5–10 mm, usually at the navel. Through this opening and with the use of a trocar (a tube that passes through the abdominal wall and allows access to the inside of the abdomen), CO2 gas is introduced to expand the abdominal cavity, enabling better visualisation of all intra-abdominal organs. In addition, 1 to 3 long, thin laparoscopic instruments are inserted through corresponding small incisions. After completion of the procedure, all instruments are removed and the gas is released from the abdominal cavity, while the sutures used to close the incisions are specially designed to minimise scarring and facilitate recovery.
The duration of the procedure depends on the case, such as removal of an ovarian cyst or a laparoscopic hysterectomy.
Advantages Of This Procedure
Laparoscopy is an almost bloodless surgical method that offers significant advantages over traditional open surgery, such as:
● better cosmetic outcome due to very small incisions, which are almost invisible after a few months
● less pain after surgery
● short hospital stay, which may range from none to a single overnight stay, depending on the type of surgery
● minimal use of painkillers
● rapid return to daily activities
● lower likelihood of adhesions due to minimal exposure of the surgical field, fewer manipulations, and less trauma to adjacent organs
● reduced blood loss
Recovery
Recovery is usually short. The woman can typically be discharged from hospital within 12–48 hours after the procedure and will usually need, for a few days, mild oral painkillers and antibiotics. During the first 1–2 days, mild weakness may occur due to general anaesthesia, while a mild bloated feeling caused by residual air in the abdomen subsides within a few days. The patient can return to daily activities within the following days.
Gynaecologist Dr D. Koleskas has served as Consultant Head of the Laparoscopy and Hysteroscopy (Minimally Invasive Surgery) surgical team at the university hospital Royal Victoria Infirmary, Newcastle, United Kingdom. He has performed a large number of laparoscopic procedures such as:
● definitive treatment of endometriosis
● release of adhesions that cause pain or infertility
● removal of ovarian cysts
● removal of ectopic pregnancy
● removal of uterine fibroids
● hysterectomy (for benign conditions or cancer)
● removal of ovaries and fallopian tubes (salpingo-oophorectomy)
In 2009, he specialised in advanced laparoscopy at Royal Victoria Infirmary, Newcastle. Certification from the Royal College of Obstetricians and Gynaecologists of the UK: Benign Gynaecological Surgery: Laparoscopy, R.C.O.G.
The experience he gained throughout his career in the UK in the field of laparoscopy enables him to help women make decisions about whether surgery is necessary for a particular problem, what alternative treatments (other than surgery) are available, and—if surgery is indicated—how extensive an operation will be required. Dr Koleskas’ principle as an endoscopic surgeon is that the most appropriate decision about surgery is made in each case together with the patient, who is fully informed about the pros and cons of all possible treatment options. For more information about what laparoscopy is, as well as its cost, please contact the doctor and schedule your appointment.
