Laparoscopic surgery, commonly referred to as minimally invasive surgery, has found a wide range of applications worldwide since the 2000s. Many surgical procedures are now performed using instruments inserted through small incisions rather than large cuts in the abdominal wall.
There are two types of minimally invasive surgery used in gynecology:
In the following article, you can find answers to questions about gynecological laparoscopy and hysteroscopy, which allow a person in an active work life to return to their daily work and home life with much less pain and a shorter hospital stay, and whose preference is increasing day by day. Questions include: what is gynecological laparoscopic surgery or minimally invasive surgery, what surgeries can be performed with minimally invasive surgery, what are the advantages of minimally invasive surgery, how is gynecological laparoscopy performed, what surgeries can be performed minimally invasively in gynecological diseases, and who can perform laparoscopy.
Laparoscopy has been presented as an important alternative surgical method to open surgery used in classical gynecological operations.
When the first cases were performed in the 1980s, the lack of appropriate surgical equipment and technology was seen as a significant obstacle. However, with the advancement of technology and the widespread training of these surgeries, minimally invasive surgery has rapidly become prevalent in all surgical medical branches.
While laparoscopy is commonly known as minimally invasive surgery, the images provided by high-resolution and magnifying cameras entering the abdominal cavity are extremely clear and distinct. The camera and accompanying laparoscopic instruments can easily reach deep areas that are very difficult to access in open surgeries.
The goal is to inflate the abdominal cavity at the beginning of the surgery using a needle (Veress needle) inserted through the navel and perform the surgery within an air chamber.
The use of laparoscopic surgery in gynecology has developed and found applications much later compared to its use in urology and general surgery.
Laparoscopy has become the first choice in many surgeries performed for women's diseases, such as the ligation of fallopian tubes (tubal ligation),removal of ovarian cysts (ovarian cyst surgery),ectopic pregnancy surgery, treatment of chronic pelvic pain, treatment of female infertility, treatment of endometriosis (chocolate cyst disease),removal of uterine fibroids or myomectomy (fibroid surgery),laparoscopic hysterectomy (removal of the uterus),pelvic organ prolapse surgeries (where the uterus, bladder, and rectum prolapse into the vagina),stress urinary incontinence surgeries, and cancer surgeries of the female reproductive organs.
Laparoscopic surgery is as reliable as open surgery in trained hands and has many advantages.
The surgeries that can be performed minimally invasively for women's diseases can be summarized as follows:
When comparing laparoscopic surgery, or minimally invasive surgery, to open surgery, we can see that it has many advantages.
In addition to all the advantages of laparoscopic surgery, it also carries the risks and complications associated with open surgeries. High technology is used in minimally invasive surgery, and there can be life-threatening vascular and bowel complications in centers without experience in minimally invasive surgery. Therefore, careful patient selection and thorough preoperative preparation are essential.
The advancement of technology has begun to be seen as innovations in the field of gynecological laparoscopy. These include:
These methods have advantages and disadvantages compared to traditional laparoscopy. Among the developing technologies, robotic surgery has created a significant change in clinical approach. The advantages of robotic surgery include ease in suturing and providing a three-dimensional view, as well as a shorter learning curve. However, it has not been shown to have superior surgical outcomes compared to traditional laparoscopy. The most significant disadvantage of the robotic system is its high setup and operating costs. Most insurance plans do not cover these costs, which are passed on to the patient.
Diagnostic laparoscopy is often a tool needed by an obstetrician to evaluate sudden or chronic pelvic pain, detect ectopic pregnancy, assess the spread of endometriosis, or evaluate the patency of the fallopian tubes.
The first entry point, often referred to as the port (an instrument with a silicone interior that prevents the escape of CO2 used to create an intra-abdominal space while allowing instruments to enter the abdomen),is commonly used for the optical laparoscope.
Laparoscopy, also known as a telescope or lens, is the surgeon's eye moving inside the abdominal cavity. It can be flexible or rigid.
Flexible ones provide an excellent view of every region of the abdominal cavity due to their bendable structure at the tip. They are mostly placed inside the navel, just below its lower edge. The images obtained from here are transmitted to a monitor with the help of an optical camera.
After the initial images and organs inside the abdominal cavity are evaluated, other ports are systematically placed in the suprapubic region and the lateral areas of the abdomen. Rod-shaped instruments, 36-42 cm long and with different tip structures, are sent through the trocars (ports) from outside the abdomen, allowing the surgeon to perform surgical procedures inside the abdomen. These are sensitive instruments that can be used once or multiple times after sterilization.
Devices called manipulators, inserted into the uterus from the vagina, help both in evaluating the patency of the fallopian tubes by injecting dye and in facilitating the surgical procedure by moving the uterus. Advanced versions of these devices are widely used in total laparoscopic hysterectomy (removal of the uterus laparoscopically) operations.
In minimally invasive surgery, the surgeon's movements are performed millimetrically while looking at the monitor. Therefore, surgical precision is high under general anesthesia, and it is done with endotracheal intubation. However, in patients where increasing intra-abdominal pressure is risky or general anesthesia cannot be administered, short diagnostic procedures can be performed with spinal or epidural anesthesia by keeping the intra-abdominal pressure low.
Hysteroscopy is the evaluation of the uterine cavity and the ostium (the part where the fallopian tubes open into the uterus) with a thin optical system mounted on a camera system, entering through the cervix for diagnostic or therapeutic purposes. During the procedure, both diagnosis (diagnostic hysteroscopy) and treatment (operative hysteroscopy) of intrauterine anomalies can be performed.
For pregnancy after embryo transfer, the endometrium (the inner lining of the uterus) and the embryo must interact. Success in IVF treatment is possible with the establishment of this interaction.
Problems inside the uterus can prevent the embryo from implanting. Hysteroscopy is an effective technology used in diagnosing and treating problems such as fibroids, polyps, and adhesions. Therefore, to increase the chances of success in IVF treatment, we aim to correct intrauterine pathologies before embryo transfer.
Diagnostic hysteroscopy can be performed in an outpatient setting half an hour after administering a sedative. If operative hysteroscopy is planned in the same session, it is appropriate to perform the procedure under general anesthesia in an operating room.
The uterus is inflated with saline, and the optical system inserted through the cervix transmits the image to the screen, identifying the problems. The hysteroscope's optical system has different types of cutting and hemostatic tips on its outer sheath. The procedure is done on an outpatient basis, and the patient can go home the same day.
During hysteroscopy, complications such as fluid passing into the bloodstream causing brain edema, complications related to anesthesia, uterine perforation during the procedure with cutting instruments, cervical injury, excessive bleeding, and intrauterine infection can occur.
Hysteroscopy is performed within the week following the end of menstruation. During periods outside this week, the thickened endometrium can obscure the image.
Hysteroscopy is an outpatient procedure. The patient can go home the same day. Vaginal discharge, cramps, or pelvic pain after the procedure are normal. If there is severe abdominal pain, fever, foul-smelling and excessive discharge, or heavy bleeding, the patient should be evaluated for the risk of endometritis (uterine lining infection).
Will There Be a Surgical Scar in Minimally Invasive Surgery?
In minimally invasive surgeries, depending on the type of surgery, instrument entry scars of 5 mm to 10 mm can be seen in the groin area below the bikini line. The entry site of the laparoscope inserted through the navel does not leave a scar when the appropriate technique is used.
What Does Laparoscopic Mean?
A laparoscope is a high-resolution camera system used to observe the abdominal cavity through the navel. Therefore, surgeries performed using this device are called laparoscopic surgeries.
How Long Does Laparoscopic Surgery Take?
The duration of minimally invasive surgery can vary between one and three hours, depending on the type of surgery.
Can I Have Minimally Invasive Surgery Without General Anesthesia? What Type of Anesthesia is Used for Laparoscopy?
General anesthesia is necessary to stop diaphragm movements and perform millimetrically precise surgery. In mandatory situations, spinal or epidural anesthesia can be used for short surgeries with low intra-abdominal pressure.
How Should I Prepare Before Laparoscopic Surgery?
Routine preoperative preparations, such as tests and a 6-8 hour fasting period, are applied in minimally invasive surgeries as well. In addition, if there have been previous surgeries, there is a possibility of intra-abdominal adhesions, or the surgery involves the intestines, a colonoscopy diet starting three days before the surgery and an enema six hours before the surgery may be recommended.
How Many Days After Minimally Invasive Surgery Can I Be Discharged?
Patients are typically discharged within 12-24 hours after minimally invasive surgery. For surgeries involving the intestines, this period can be extended to 5-7 days to monitor for fecal leakage inside the abdomen.
How Many Days After Minimally Invasive Surgery Can I Return to Work?
Patients can perform daily tasks within two days and return to work within seven days after laparoscopic surgery.
How Soon After Minimally Invasive Surgery Can I Travel?
Patients can travel by air or land 24 hours after minimally invasive surgery.
Are Stitches Removed After Minimally Invasive Surgery?
In most cases, aesthetic subcutaneous stitches used in minimally invasive surgeries do not need to be removed.
Should I Use Medication After Laparoscopic Surgery?
If there are no additional problems after minimally invasive surgery, only pain relievers are recommended.
