Advanced gynaecological laparoscopic surgery

Hysterectomy is an operation to permanently remove the uterus (or womb). ‘Total’ hysterectomy is when the cervix is also removed, which is standard practice. ‘Sub-total’ hysterectomy is when the cervix is left inside. Hence, ‘total laparoscopic hysterectomy’ is an operation to remove the uterus and cervix using keyhole (or laparoscopic) surgery.

Standard practice is to remove both the left and right Fallopian tubes whenever a hysterectomy is performed, a procedure called a ‘bilateral salpingectomy’. This is because, once the uterus has been removed, the Fallopian tubes serve no purpose. In addition, removing Fallopian tubes reduces the risk of future ovarian cancer by 30 – 40%.

For more information about hysterectomy, please read this blog post.

When removing endometriosis, best practice is to do so using a laparoscopic (or keyhole) approach: the magnification provided by the keyhole surgery camera enables laparoscopic surgeons to zoom in on endometriotic nodules, and ensure that any visible deposits are excised (cut out).

Mild endometriosis can be safely excised by many gynaecologists who have completed basic gynaecological training; excision of moderate and severe endometriosis requires the surgical expertise and judgement of more advanced laparoscopic surgeons.

If the Fallopian tubes are thought to be blocked and filled with fluid (a condition called hydrosalpinx or hydrosalpinges), the suspected diagnosis can be confirmed using laparoscopic surgery. If needs be, the Fallopian tubes can then be excised (‘bilateral salpingectomy’).

Urogynaecologists often use a laparoscopic approach to manage pelvic organ prolapse (using an operation called a laparoscopic sacrocolpopexy) and stress urinary incontinence (using a Burch colposuspension).

Myomectomy is an operation to remove fibroids, which are common, benign overgrowths of the muscle of the uterus. Depending on the size, number, and location of the fibroids, the surgical approach to remove them may be:

• Hysteroscopic (an operation performed through the vagina, without causing any scars in the tummy)
• Laparoscopic (using a keyhole, or minimal access, technique)
• Or open (or ‘abdominal’, which involves a 10 – 15cm scar in the tummy)

Laparoscopic myomectomy requires advanced laparoscopic gynaecological skills and expertise, such as that gained by Maven Centre’s Drs Sneha Parghi and Alison Bryant-Smith.

An ovarian cyst is a fluid-filled sac within your ovary.

Many ovarian cysts can be safely removed using a laparoscopic (keyhole surgery) approach. First, the cyst is shelled out from within the ovary surrounding it. Simple cysts can then be drained, and removed through one of the keyhole surgery scars. To remove large solid cysts, one of the keyhole surgery scars may need to be made slightly larger (eg. 2 – 3cm).

Sometimes known as keyhole surgery, laparoscopic surgery is a surgical technique that is minimally invasive. Small (5 – 10mm) incisions are made, and specialised surgical instruments used, to access and operate on internal organs and structures.

Laparoscopic surgery is performed using small (5 – 10mm) incisions, and a specialised surgical video camera called a laparoscope. This allows laparoscopic surgeons to view and operate inside the body with minimal invasiveness.

Yes, laparoscopic surgeries are generally safe, but (like any surgical procedure) it does carry some theoretical risks. Complications can include: bleeding; infection; damage to surrounding organs; or anaesthesia-related complications. Nonetheless, complications are rare, and patients usually recover quickly.

Recovery time varies depending on the individual patient, the nature of the procedure, and other factors. Generally, patients recover within a few days to a couple of weeks. Recovery time is usually faster than after open surgery.

Your laparoscopic surgeon will provide specific instructions according to the procedure you’re undertaking. This may include: fasting before the procedure; informing your doctor about existing medical conditions or allergies; or stopping certain medications. If you’re unsure of what to do before the surgery, check with your clinician.

Yes, laparoscopic surgery is performed under general anaesthesia. This means you will be asleep during the procedure, and will not feel or remember anything about the actual operation.

Compared to open surgery, advantages of laparoscopic surgery include:

• Smaller incisions, which result in smaller scars
• Reduced pain and discomfort after your operation
• Faster recovery, which means a shorter hospital stay, and faster return to your usual activities
• Lower blood loss during your operation
• Lower risk of blood clots forming in your legs or lungs
• The laparoscope (or surgical video camera) provides enhanced magnification and visualisation of anatomical structures, which enables better precision and accuracy during your operation

Laparoscopic surgery is considered a minimally invasive procedure compared to traditional open (or abdominal) surgery. Thus, it is usually not considered major surgery, and is typically associated with a quicker recovery.

The duration of a laparoscopic operation depends on various factors, principally the specific operation being performed. Your laparoscopic surgeon may take only half an hour for simple procedures, or up to several hours for more complex operations.

You will still have visible scars, even with laparoscopic surgery. However, because the incisions are small (5 – 10mm), scarring is minimal compared to larger (10 – 15cm) incisions from open surgery.

While laparoscopic surgery is generally associated with less pain compared to traditional open surgery, patients may still experience some pain and discomfort. Your anaesthetist will prescribe pain medication to help manage the pain.