Laparoscopy in Gynecology

Over the last four decades, laparoscopic surgery has evolved into the surgical approach of choice for many diseases. In the field of gynecology, laparoscopy can be used for both diagnosis as well as treatment of pathologies.

The ‘key hole’ surgery offers several advantages to patients such as early mobilization, lesser pain, lesser hospital stay and is more cosmetic. It also enables them to resume their routine activities at the earliest.

Once used only for diagnostic purposes, laparoscopy is now being used to treat almost every kind of benign pelvic disease as the experience of the surgeon increases. Size of the pathology may be a restrictive factor, but these too can be overcome by the surgeon with time. In addition to better cameras and instruments, technology has resulted in the development of robotically assisted laparoscopy, and most recently single-port laparoscopy.

Place of laparoscopy in gynecology:

• Diagnosis:
Laparoscopy can be used to diagnose gynecological diseases such as endometriosis, structural defects of the uterus etc, which may not be diagnosed accurately with the available imaging modalities.
In cases of infertility, a laparoscopy combined with hysteroscopy enables the surgeon to thoroughly assess the woman for any anatomical problem, which would deter her pregnancy. The patency of the fallopian tubes can also be tested during the laparoscopy by injecting a dye into the uterus from the cervix and visualizing the flow of the dye through the abdominal end of the tube by means of a laparoscopic camera. Free flow of the dye indicates that the tubes are open at both ends.

• Therapeutic:
Laparoscopy can be used to perform a variety of procedures on the uterus, tubes and ovaries from a simple tubal ligation to a complete removal of uterus (hysterectomy).

Uterine procedures such as fibroid removal, septum removal etc can be done with the help of laparoscopy and hysteroscopy. Women who are undergoing hysterectomy can do so by laparoscopic approach. With the help of instruments such as morcellators, even large pathologies can be removed laparoscopically, as the morcellator shreds them into bits which can be retrieved from the keyhole incisions.

Laparoscopic surgery is indeed the procedure of choice for conditions such as unruptured ectopic pregnancies, tubal ligation procedure. Tubal pathologies such as hydrosalpinx (fluid filled tubes), hematosalpinx (blood filled tubes) can be tackled easily with laparoscopic surgery. For those who are found to have a tubal block on laparoscopy, a cannulation of the tube (passing a guide wire from end to end) may be done in attempt to open them up.

Diseases of the ovary such as chocolate cysts (endometriomas), dermoid cysts and other benign ovarian cysts can be treated laparoscopically. Infertile women with polycystic ovary syndrome can undergo laparoscopic ‘drilling’ of their ovaries, which helps correct the hormonal imbalance in their body and may assist them to get pregnancy. With this minimally invasive approach, there is very little handing of the normal tissue and thus lesser damage to them.