The Gold Standard


Over the past two decades, laparoscopic surgery has become the gold standard for treating fertility, removal of ovarian cysts, treatment of most benign tumours of the uterus and some early malignant gynaecologic conditions.

In laparoscopy, small incisions are positioned strategically around the surgical site so that telescopes attached to video cameras and surgical instruments can be inserted. The operation is performed with the surgeon viewing the process on a large monitor. Patients benefit because there is less pain and scarring than with open surgery, and usually experience faster recovery and healing.

Laparoscopic surgery is now also recognised as being generally safer than open surgery, and can be done on an outpatient basis or with a short hospital stay.

Dr Yap Lip Kee of Gynae Consultancy, a Gynaecology Clinic in Mt Elizabeth Medical Centre Singapore, and Visiting Consultant to KK Women’s and Children’s Hospital, states that laparoscopic surgery is now used in almost all treatments relating to ectopic pregnancies, adhesions, non-cancerous ovarian cysts, endometriosis, adenomyosis, fibroids and includes hysterectomies.

Adhesions, in particular, can cause infertility and pain in women, and are difficult to detect unless through laparoscopy. Usually harmless, adhesions are bands of tissue that have fused together, but which cause complications if they appear in the wrong places. They can cause intestinal obstruction by twisting parts of the intestine, for example; or closure of fallopian tubes and or covering ovaries, which prevents proper release or movement of eggs, resulting in infertility.

Laparoscopy provides the surgeon with a good view of these tissues, which increases precision when detaching them. This means less scarring and reduced chances of recurrence.

Laparoscopy also plays a major role in surgeries for uterine fibroids, uterine diseases needing hysterectomy, early uterine cancers and urinary stress incontinence, says Dr Yap, who no longer does deliveries, and focuses on gynaecology, infertility and minimally invasive surgery (MIS).

Uterine fibroids are common tumours which can grow very large if undetected, making conception difficult. If the tumours are small, laparoscopic myomectomy can be performed via a small cut near the belly button. Larger fibroids are cut down to size for extraction.

However, if there are large tumours – longer than 12cm – the traditional method (laparotomy) may be the choice of most surgeons, explains Dr Yap.

This requires an incision above the hairline (some call it the bikini cut) and the uterus being opened to allow removal of the fibroids. It is then closed, often with two or more layers of stitching, to ensure better healing and strengthening of the site for the pressures of future childbearing.

Because of its versatility, laparoscopic surgery can be performed to complement open surgery in cases when it cannot be a direct replacement.

Dr Yap also sees variations of MIS playing a vital role in the future, for complex surgical treatments such as in uterine prolapse and early cervical cancer.

There are currently two versions of MIS: traditional laparoscopic surgery and robotic surgery. Robotic surgery uses robotic arms controlled by the surgeon who sits away from the operating table. Both versions of laparoscopic surgery offer the advantage of a magnified view, 3D imaging and an approach through small incisions. The robotic advancement combines robot-assistance with laparoscopy and adds an even higher level of precision, flexibility and control from a more steady platform. This is achieved with the use of a multimillion- dollar machine.