Laparoscopy : A kinder, gentler surgery

Laparoscopic surgery is major surgery done through small cuts (incisions) of between half to one centimeter in the patient’s belly. This form of surgery is also known as ‘minimally invasive surgery’, ‘operative endoscopy’ and ‘keyhole surgery’.

After the incisions are made, the surgeon inserts a thin telescopic instrument to which a camera is attached. This goes through the belly button incision. The camera transmits an image of the organs inside the abdomen onto a television monitor outside. The surgeon is therefore able to see directly into the patient’s body without the traditional large incision.

With this approach, the gynaecologist can remove ovaries, ovarian cysts, fibroids or even the whole uterus from the patient’s body. In other specialities, surgeons have followed suit and adopted this method to remove the gall bladder, appendix, parts of the intestine and even the spleen, kidney and prostate.

When would minimally invasive surgery (MIS) be a good option?
Laparoscopic surgery is now the operation of choice for treatment of most gynecological problems needing surgery. In fact, more than 80% of patients with ovarian cysts, for instance, opt for this approach. Almost all patients with ectopic pregnancies are recommended and accept laparoscopy as the best treatment. More than half of the women in Singapore needing hysterectomy or myomectomy have access to gynecologists and facilities capable of successfully performing the surgery laparoscopically.

Gynecological conditions suited for laparoscopic surgery include:

  • Ectopic pregnancies (pregnancies in which the foetus develops outside the womb, typically in a fallopian tube)
  • Pain due to adhesions
  • Ovarian cysts
  • Endometriosis
  • Uterine fibroids
  • Uterine diseases needing hysterectomy, such as adenomyosis and some fibroids
  • Early uterine cancers
  • Some ovarian cancers
  • Urinary stress incontinence

Advantages of MIS
Better visibility. Contrary to common belief the view during laparoscopy is far superior to that during laparotomy. This is because the high definition cameras now available provide a highly magnified view of the operation site, so much so that this is likened to microsurgery.

Reduced pain and faster recovery. Because of the small incision size, the procedure is less painful and the recovery faster than in surgery done through one large cut.

The hospital stay is usually shorter and the patient can return to work and their regular activities sooner.

There may also be less internal scarring compared to traditional open surgery, mainly because there is less cutting of the abdomen and the magnification allows for more precise surgery.

From a cost perspective, laparoscopy may also cost less than open surgery. Although equipment and consumables used in the surgery cost more and the duration of the surgery is longer compared to open surgery, the cost saving is in the reduced hospital stay and earlier return to normal functioning and economic productivity.

Any disadvantages to MIS?
Gynaecologists tend to be cautious when dealing with possible cancers as incomplete removal or spillage of cancerous tissue is sub-optimal surgery and worsens the patient’s chance of survival.

These include precautions for removal of tissue and not recommending laparoscopic surgery when there is a more than 1% risk that we are dealing with a cancer of the uterus or ovaries.

When improved equipment is available and better techniques developed most early gynecological may be safely dealt with by laparoscopic methods.