LAPAROSCOPIC (KEYHOLE) SURGERY

Laparoscopic (keyhole) surgery is a minimally invasive technique that has revolutionized the field of surgery.

Every day hundreds of women in Australia undergo surgery for treatment of gynaecologic problems. Until recently this involved open abdominal surgery for the treatment of common conditions such as fibroids, removal of uterus (hysterectomy), cysts in ovaries, endometriosis or chronic pelvic pain. Today, however, modern technology allows us to complete the same standard surgeries using far less invasive techniques – the Minimally Invasive Surgery (MIS), also called laparoscopic surgery or keyhole surgery.

What happens in laparoscopic surgery?

Instead of making a large incision through the skin (laparotomy, or open surgery), a laparoscopic surgeon makes just a few tiny incisions to perform the surgery. These 0.5-1-cm incisions serve as entry ports for a long, narrow camera and other laparoscopic instruments. The high-definition camera shows a magnified view of the pelvic organs to the surgeon. Specially designed instruments enable the surgeon to perform all the delicate manoeuvres to remove diseased tissue precisely, have a meticulous control of bleeding, and even carry out fine tissue suturing.

Laparoscopic surgery offers a safe and effective alternative to open surgery. No more need for painful procedures and large incisions.

The benefits of laparoscopic surgery:

Since laparoscopic surgery causes less trauma to the body, recovery is much faster than with traditional open surgery. As the incisions are much smaller, pain is significantly reduced with less need for pain medication after surgery. Patients can often get up within a few hours of surgery.

Hospital stay is reduced to 1-3 days, compared to up to a week following open surgery. Many procedures can be even done as single-day surgery. This means recovering in the comfort of your own home and being able to resume employment within a few weeks.

In addition to the better cosmetic healing of small incisions, laparoscopic surgery also reduces the risk of infection, because tissues are not exposed as they are in open surgery.

In summary the benefits of laparoscopic surgery are:

• less pain
• less trauma and less invasive
• less scarring
• shorter hospital stay
• quicker recovery and return to normal activity

	Laparoscopic surgery	Open surgery
Scar size	A few small 0.5 - 1cm	Large 8 - 10cm
Need for pain medication	Reduced	Significant
Hospital stay (average)	0 - 3 days	5 - 7 days
Time off work	1 - 3 weeks	4 - 6 weeks
Risk of infection	Lower	Higher
Wound problems	Less because of smaller wounds	More

Conditions suitable for laparoscopic surgery:

Laparoscopic surgery can replace open surgery in treatment of many of the non-cancerous gynaecologic conditions. Examples are heavy periods, fibroids, hysterectomy, cysts of ovaries and endometriosis.

Check out our Procedures or Gynaecologic services to know more about these surgeries.

What are the risks?

All types of surgery carry risks. Indeed, it would have been unrealistic to expect any surgery to be absolutely risk-free. Generally, laparoscopic surgery is regarded as safe and its associated risks are uncommon. Most of these risks happen at the same rate, if not lower, as in traditional open surgery.

• Side effects due to anaesthesia (temporary nausea, vomiting)
• Infection - E.g. fever after operation, urinary tract infection, wound infection. The vast majority of infection problems can be effectively treated with antibiotics.

Serious complications after laparoscopy are rare. It is estimated that they happen in one out of every 1,000 cases. Serious complications include:

• Injury to nearby organs such as bowel, bladder or urethra. These injuries are usually fixed with surgery.
• A blood clot developing in a vein (deep vein thrombosis - DVT). Early mobilization after a laparoscopic surgery is one way to reduce the risk of post-operative DVT.

Other factors such as patient’s age, general health, the reason for surgery, previous pelvic or abdominal surgery, previous Caesarean sections and the complexity of laparoscopic surgery also contribute to the specific risk of an individual patient.

During your personal consultation, our doctor will talk in depth about the risks in specific to your individual condition.

What to expect after a laparoscopic surgery?

Recovery following surgery depends on the type of procedure you have undergone. In general, it is common to experience the following symptoms for 1-2 days:

• Pain at the site of incisions – Adequate pain medication will be provided.
• Shoulder tip pain - Laparoscopic surgery involves inflating the abdomen with carbon dioxide gas. The residual gas may irritate the diaphragm, resulting in referred pain at the shoulder tips. This pain will resolve in 1-2 days as the gas naturally absorbed by the body.
• Mild nausea after general anaesthesia
• Mild bloating sensation over stomach – because of the residual carbon dioxide ga.s
• Minor bleeding and bruising around the incision – If present, they may appear unsightly in the first few days after the surgery. However, these marks are almost always self-limiting and would not leave extra scar on the skin.
• Mild vaginal bleeding - it may resemble a light menstrual period and the amount will be decreasing in the following days.

Recovery at home

Following a laparoscopic surgery, patients can return home much earlier than those who have undergone an open surgery. You will receive instructions on wound care from the nursing staff before going home. Our doctor will explain your recovery course in specific to the procedure you have had. We will also advise you the best time for a complimentary follow-up visit.

Your Choice. Our Mission.

We firmly believe in the great benefits of keyhole surgery to our patients.

Unfortunately, because it requires sophisticated equipment, not all hospitals in Australia and New Zealand are able to offer laparoscopic surgery. It also requires specialized training, even for surgeons who are experts at open surgery.

Indeed, many women are not made aware of laparoscopic surgery as an alternative to open surgery. Many are even advised against it due to lack of expertise or equipment.

We are dedicated to bringing the benefits of this advanced and less invasive procedure to all women requiring surgery for their gynaecologic conditions. We promise to empower women, offer choices and practice the best medicine to improve our patients’ quality of life.

If you are considering having minimally invasive surgery as a treatment for your gynaecological condition, please contact us for a personal consultation and discussion of your case.