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Laparoscopy

 

Laparoscopy, also called minimally invasive surgery (MIS), or keyhole surgery, is a technique in which operations in the abdomen are performed through small incisions as compared to larger incisions needed in open surgery. Laparoscopic surgery includes operations within the abdominal or pelvic cavities. Laparoscopy was initially used primarily for diagnosis in cases of chronic pelvic pain, pelvic masses, or for the suspicion of an ectopic pregnancy. The first surgical intervention to be performed bv laparoscope was tubal sterilisation. With advances in technology and instrumentation as manv as 80 per cent of gynaecological operations can now be performed endoscopically.

 
Advantages

When compared to conventional open surgery it has the following advantages:

  • Rapid postoperative recovery
  • Less postoperative pain and reduced need of postoperative analgesia
  • Although procedure times are usually slightly longer, hospital stay is less, and often with a same day discharge which equals a faster return to everyday living.
  • Reduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections and postoperative adhesions.
  • Less adhesion formation
  • Reduced blood loss, which equals less risk of needing a blood transfusion.
  • Smaller abdominal scars (cosmetic value).
 
Disadvantages

Fundamentally laparoscopic surgery differs from its laparotomic counterpart only by its particular mode of access. However, it is intrinsically more difficult to perform than laparotomy due to:

  1. Indirect palpation of tissues through a finite number of immovable ports
  2. Restriction of axial freedom
  3. Replacement of normal stereoscopic three-dimen­sional visualisation by two dimensional video image
  4. Higher initial expenditure (instrument cost). Despite these challenges, given proper surgical case

selection and the requisite surgical training, it promises to result in at least equivalent results, better cosmesis, less postoperative pain and faster recovery.

 
Indications For Laparoscopy
Diagnostic Laparoscopy

Non-acute conditions

  1. Evaluation in infertility
  2. Chronic pelvic pain
  3. Suspected endometriosis
  4. Evaluation of mullerian anomaly
  5. Prior to tuboplasty

Acute conditions

  1. Acute abdominal pain
  2. Suspected ectopic pregnancy
  3. Acute pelvic inflammatory disease
  4. Torsion of adnexa
 
Operative Laparoscopy
In addition to providing diagnostic accuracy, the laparoscope may be used to safely carry out many surgical operations. The indications for these procedures are the same as for laparotomy (Table 49.1).
Laparoscopy has a more limited place in the primary staging, treatment, and follow-up of patients with gynaecological malignancies, but radical hysterectomies, pelvic and para-aortic lymphadenectomies have been performed laparoscopically.
 
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