Laparoscopy - Brisbane Pelvic Surgery Clinic

Laparoscopy

Laparoscopy, also known as “keyhole surgery”, refers to a surgical technique where small incisions (5-10mm in length) are made in the abdomen and pelvis to allow access for specialised instruments.

A laparoscope is a long thin instrument which allows light to travel in and out of the abdominal cavity. A fibre optic cable conducts an extremely bright light through the laparoscope to the intra-abdominal organs, which is reflected back to the laparoscope. The laparoscope then transmits the data to an ultra high definition camera. A live feed is then displayed for the surgeon and the surgical assistant, providing a real-time view of what’s happening inside the body.

Laparoscopy enables magnification of the entire abdominal cavity and pelvis for a thorough investigation by the gynaecologist. The gynaecologist can then diagnose and treat diseases pertaining to ovaries, uterus and Fallopian tubes. Gynaecological oncologists are highly experienced in using laparoscopy to perform surgery on the pelvic side walls, allowing them to remove pelvic lymph nodes and other tissues which may be affected by gynaecological malignancies. The level of magnification the laparoscope provides may help to view even the most subtle disease processes and lesions that may not have been identified in traditional open surgery.

The video below gives an inside look of the scope of a Laparoscopy and highlights some of the indications for undergoing the procedure.

Advantages

The advantages of keyhole surgery include faster recovery and return to normal work and activities, less pain after surgery, shorter hospitalisation, better cosmetic outcome with smaller scars and better visualisation of disease by the surgeon (allowing more accurate diagnosis and precise treatment)

Benign Indications

Dr Amy Tang specialises in performing laparoscopy for both benign and malignant gynaecological conditions. She performs total laparoscopic hysterectomy (removal of the uterus), laparoscopic salpingo-oophorectomy (removal of the ovaries and tubes), laparoscopic lymphadenectomy (removal of lymph nodes) and laparoscopic resection of endometriosis.

Common benign indications for Total Laparoscopic Hysterectomy include heavy periods (menorrhagia), adenomyosis, fibroids and prolapse.

Laparoscopic Procedures

Hysterectomy

Hysterectomy is the surgical removal of the womb (body of uterus and cervix). The operation may be with or without the removal of the ovaries.

The uterus is a muscular organ of the female body, shaped like an upside-down pear. The lining of the uterus (the endometrium), thickens and after ovulation is ready to receive a fertilised ovum (egg). If the ovum is unfertilised, the lining comes away as bleeding. This is known as menstruation (period). If the ovum is fertilised, the developing baby is nurtured inside the uterus throughout the nine months of pregnancy.

Once a woman has had a hysterectomy, she will no longer have menstrual periods and cannot have a child. She no longer needs to use contraception.

Hysterectomy is used to treat a number of conditions, such as excessive menstrual bleeding. Every year in Australia, around 30,000 women have a hysterectomy. Some people are concerned that more hysterectomies are performed than are necessary.

Salpingectomy

Salpingectomy is the removal of one or both of a woman’s fallopian tubes, the tubes through which an egg travels from the ovary to the uterus.

A salpingectomy may be performed for several different reasons. Removal of one tube (unilateral salpingectomy) is usually performed if the tube has become infected (a condition known as salpingitis). Salpingectomy is also used to treat an ectopic pregnancy, a condition in which a fertilized egg has implanted in the tube instead of inside the uterus. A bilateral salpingectomy (removal of both the tubes) is usually done if the ovaries and uterus are also going to be removed. If the fallopian tubes and the ovaries are both removed at the same time, this is called a salpingo-oophorectomy. A salpingo-oophorectomy is necessary when treating ovarian and endometrial cancer because the fallopian tubes and ovaries are the most common sites to which cancer may spread.

Ovarian Cystectomy

Ovarian Cystectomy is a surgical excision of an ovarian cyst. Cystectomy is a surgical procedure during which the ovarian cyst is removed either with laparoscopy, or an open surgery. A laparoscopic cystectomy procedure is a minimally invasive surgery during which a laparoscope, a long thin instrument with a camera attached at one end is used. The procedure is usually done under general anaesthesia and a small incision is usually made below the navel. A laparoscope is inserted through this incision to see the inside of your pelvis and abdomen. Carbon dioxide gas is introduced into the abdominal cavity to create more space to work. Your surgeon identifies the cyst through the scope and removes the cyst. This technique is usually used to remove small cysts.

Oophorectomy

Oophorectomy is the surgical removal of the ovaries, the part of a woman’s reproductive system that stores and releases eggs for fertilization and produces female sex hormones.

Oophorectomy may be done alone or as part of a hysterectomy.

Oophorectomy is often needed when pelvic disease, such as ovarian cancer, is present. And it is sometimes recommended when the hormones produced by the ovaries are making a disease such as breast cancer or severe endometriosis worse.

In some cases the ovaries are removed to try to reduce the possibility of developing a future disease, such as ovarian cancer. This is called a prophylactic oophorectomy.

Myomectomy

Myomectomy is the surgical removal of fibroids from the uterus. It allows the uterus to be left in place and, for some women, makes pregnancy more likely than before. Myomectomy is the preferred fibroid treatment for women who want to become pregnant. After myomectomy, your chances of pregnancy may be improved but are not guaranteed.

Before myomectomy, shrinking fibroids with gonadotropin-releasing hormone analogue (GnRHa) therapy may reduce blood loss from the surgery. GnRHa therapy lowers the amount of oestrogen your body makes. If you have bleeding from a fibroid, GnRHa therapy can also improve anemia before surgery by stopping uterine bleeding for several months. However GnRHa is not a long-term solution for the management of fibroids, as osteoporosis (bone loss) occurs after 6-12 months of GnRHa therapy.

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