Improvements In Gynaecology

Laparoscopic or key-hole surgery is now accepted as the method of choice to treat many gynecological conditions including ectopic pregnancies, ovarian cysts, fibroids, endometriosis, adhesions and the diseased uterus or fallopian tube. Patients experience shorter downtime, less discomfort and better cosmetic results with this effective and modern technique. Surgeons using this method find the are able to get a clearer and magnified view of the diseased organs and hence able to operate more efficiently.

One of the uses for key-hole surgery in gynaecology is the removal of ovarian cysts. Before the emergence of the key-hole method, it was done by open surgery. In such procedure, the surgeon has to make a cut in the abdomen. The muscles are separated and the abdomen opened. The surgeon will use clamps to secure the operating site and proceed with the drainage and removal of the cyst wall (Figure 1A). This traditional method will result in a larger scar, more tissue damage and hence a longer recovery time. Patients experience more pain and discomfort after the surgery.

Ovarian cysts now can be removed through a keyhole surgery. In the leading hospitals in Singapore as much as 85 percent of ovarian cysts are now operated in this fashion.

A small incision is made at the umbilicus area and carbon dioxide gas used to inflate the abdomen, creating a space for the gynecological surgeon to work. A small, telescope like instrument with a camera attached brings the view of the area to be operated on to the television screen allowing the whole team to view the surgery. Using a few additional cuts the surgeon introduces tiny (5 mm thick) instruments to grasp and cut tissue, removing the cysts contents with a suction device and dissecting the cyst wall free for removal in a bag to prevent spillage. The ovary is washed to identify the bleeding points and they are cauterised to secure hemostasis.

Most women with non-cancerous tumors can now safely opt for laparoscopy. In the past gynaecological surgeons were more comfortable with the open method, laparotomy. However, now we have managed to train a generation of surgeons capable of doing laparoscopy, hence administering a "kinder cut".