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| Laparoscopic surgery, also called minimally invasive surgery (MIS)/ bandaid surgery/ keyhole surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5–1.5 cm) as compared to the larger incisions needed in laparotomy. |
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| Keyhole surgery uses images displayed on TV monitors for magnification of the surgical elements. |
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| Laparoscopic surgery includes operations within the abdominal or pelvic cavities. |
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| There are a number of advantages to the patient with laparoscopic surgery versus an open procedure. These include reduced pain due to smaller incisions and shorter recovery time. |
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| The key element in laparoscopic surgery is the use of a laparoscope - a telescopic rod lens system which is connected to a video camera (single chip or three chip). Also attached is a fiber optic cable system connected to a 'cold' light source (halogen or xenon), to illuminate the operative field, inserted through a 5 mm or 10 mm cannula or trocar to view the operative field. The abdomen is usually insufflated, or essentially blown up like a balloon, with carbon dioxide gas. This elevates the abdominal wall above the internal organs like a dome to create a working and viewing space. CO2 is used because it is common to the human body and can be absorbed by tissue and removed by the respiratory system. It is also non-flammable, which is important because electrosurgical devices are commonly used in laparoscopic procedures. |
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| Indications |
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| Diagnostic Laparoscopy |
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| Frequently, the physician needs to assess the pelvis for acute or chronic pain, ectopic pregnancy, endometriosis, adnexal torsion, or other pelvic pathology. Determination of |
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| tubal patency may also be an issue. Usually, a primary port for the laparoscope (also known as the "lens") is placed infraumbilically and a second port is placed suprapubically to probe systematically and observe pelvic organs. If needed, a biopsy specimen can be obtained to aid in the diagnosis of endometriosis or malignancy. If tubal patency is a concern, use of a uterine manipulator with a cannula allows a dilute dye to be injected transcervically (chromopertubation). |
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| Diagnostic laparoscopy is usually performed under general anesthesia. |
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| Tubal Sterilization - |
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| Trocar placement is similar to diagnostic laparoscopy. Bipolar electrosurgery, clips, or silastic bands may be used to occlude the tubes at the mid-isthmic portion, approximately 2-3 cm from the cornua. Pregnancy rates vary by patient age, ranging from 1-3% after 10 years same as open sterilization. |
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| Lysis of Adhesion - |
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| Adhesions may form due to prior infection, such as a ruptured appendix or pelvic inflammatory disease (PID), endometriosis, or previous surgery. Adhesions may contribute to infertility or chronic pelvic pain. |
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| Treatment of Endometriosis - |
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| Laparoscopy is the most common procedure used to diagnose and treat endometriosis. Endometriotic lesions may be resected or ablated. Both of these techniques have shown to improve fertility and decrease pelvic pain in multiple well-designed studies. |
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| Treatment of Ectopic Pregnancy - |
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| Laparoscopy is the surgical approach of choice for most ectopic pregnancies. A salpingostomy or salpingectomy may be performed to remove the embryo and gestational sac. Laparoscopy is very useful in preserving fertility. |
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| Ovarian Cystectomy - |
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| If a simple ovarian cyst sized 6 cm or larger persists for 2 or more cycles in a premenopausal, nonpregnant female, a cystectomy is indicated. This can be achieved using laparoscopy or laparotomy depending on the cyst size and the likelihood of the presence of malignancy. |
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| Oophorectomy - |
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| An oophorectomy may be more appropriate in postmenopausal women with a growing or persistent cyst.4 A tubal pregnancy or large hydrosalpinx with adhesions may also require ovary removal. |
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| Myomectomy - |
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| Many women with a symptomatic fibroid uterus prefer myomectomy to hysterectomy in order to preserve fertility or the uterus. If the patient has a pedunculated fibroid, the stalk may be easily incised. However, for intramural fibroids, the risk of bleeding increases. |
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| Hysterectomy - |
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| Initially, laparoscopy was performed prior to vaginal hysterectomy to restore normal anatomy. However, currently, it is often used in a variety of ways, such as assessing feasibility of a vaginal hysterectomy (when adhesions, endometriosis, or a large fibroid uterus is suggested) and performing some or all of the actual hysterectomy. The 3 basic laparoscopic approaches for hysterectomy are laparoscopic-assisted vaginal hysterectomy (LAVH), laparoscopic hysterectomy (LH), and laparoscopic supracervical hysterectomy (LSH). |
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LAVH is the most commonly employed and technically straightforward of the 3 techniques. Part of the hysterectomy is done vaginally.
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| LH, the second approach, is performed initially like the LAVH, except that the entire hysterectomy is performed laparoscopically. |
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| Oncologic Procedures - |
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| Laparoscopy has long been used in oncology for second-look procedures following surgical and chemical treatment of malignancy. |
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