Laparoscopic surgery in gynaecology: What to know

When preparing for a minimally-invasive procedure to treat or diagnose a gynaecological condition, many women naturally have questions about what to expect from their surgery and recovery period to follow. In this informative guide, revered consultant gynaecologist Mr Johnson Amu sheds light on the key benefits and risks associated with laparoscopic surgery, also known as keyhole surgery, in gynaecology. The leading specialist also discusses the differences between laparoscopic surgery and traditional open surgery, and explains which types of gynaecological issues may be treated or diagnosed using this approach.

What is laparoscopic surgery, and how does it differ from traditional surgery?

Laparoscopic surgery, also called keyhole surgery, is where you perform a procedure to assess the inside of the abdomen or tummy. Laparoscopic surgery is performed through tiny incisions on the abdomen, using special equipment which is designed to be able to go through those small incisions to perform the procedure. It is different from traditional surgery where you may end up with a big scar on the tummy which is created in order to perform the procedure.

In procedures like hysterectomy, which is removal of the womb and sometimes also the ovaries, traditionally, there was a cut made around the bikini line area which was big enough to allow the operation to take place. These days, however, this operation can be done by keyhole surgery where there are just tiny cuts on the belly button and on the side of the abdomen to perform the same procedure.

Which gynaecological conditions can be treated using laparoscopic techniques?

Laparoscopic surgery may be performed for diagnostic purposes, where we are looking for the cause of a problem, such as pelvic pain or as part of investigation for fertility. Additionally, keyhole surgery can be used as a treatment. As I previously mentioned, hysterectomy can be performed laparoscopically. Depending on the condition requiring intervention, keyhole surgery can also be used treat conditions like endometriosis, or in the removal of ovarian cysts.

What are the benefits of laparoscopic surgery for patients?

Undergoing laparoscopic surgery is good for patients in the sense that recovery is a lot quicker, with a typical path to recovery that is two weeks shorter than would be expected with traditional surgery. Keyhole surgery also offers less pain, shorter hospital stays and, of course, less scarring on the abdomen where the surgical incisions are made. Overall, this means patients can get back to normal life more quickly, with less post-operative pain, less bleeding, and a faster return to work. From the surgeon’s perspective, the view is much clearer when performing a keyhole procedure, as opposed to traditional surgery.

What is the recovery process like after a laparoscopic procedure?

This largely depends on why the procedure has been performed. If it is a quick diagnostic laparoscopy, for instance looking for the cause of pelvic pain, usually after a week or two, most people are back to work. In contrast, keyhole surgery performed to treat more serious conditions, such as a hysterectomy procedure, can carry a recovery period of four to six weeks on average. Therefore, the associated recovery process really depends on the patient’s specific situation and the motivations for performing the procedure.

Are there any potential risks or complications associated with laparoscopic surgery?

As with any type of procedure, there are risks and benefits of performing an operation via keyhole surgery. We have talked about the benefits already, but it’s also important to know that not all conditions can be treated using keyhole surgery.

If you are having a procedure done through keyhole surgery, there are some risks to be aware of that are relatively common. There can be pain after the procedure, which is usually felt on the shoulder tip, which is caused by the gas that is put inside the tummy when the procedure is being performed. Also, sometimes a bit of bleeding can occur during the operation, as well as infection. Antibiotics are not given routinely, but rather we look out for signs of any problems. There is also a small risk of scarring or hernia, which is a gaping in the incision made on the tummy.

Depending on the kind of operation performed, there is also a small risk of clotting in the leg or lungs. With shorter operations with a quicker associated recovery time, this risk becomes less. However, with major operations, it’s necessary to consider other measures to reduce the risk of clotting in the leg or lungs.

In terms of serious complications, these can occur in about one or two women out of a thousand. This may relate to injuries in the area where you operate, such as the bowel, the bladder and major blood vessels. In cases of hysterectomy or removal of a big cyst, this could affect the ureter, which is a part that connects the kidney to the bladder. In some cases, we can identify those complications and deal with them there and then, but in about 10 to 15 per cent of cases, it may not become obvious until after the woman has gone home. For this reason, we always advise that if there are any concerns or problems developed after any operation, you need to contact your GP or seek medical attention.

There are also more rare complications, which are serious, including bleeding from the main blood vessel in the area. If there are any big complications relating to the bowel, this requires conversion from keyhole surgery to an open operation to allow better access to deal with the complication. In some cases, we plan to do a procedure via keyhole surgery, like a hysterectomy, but on getting underway with the operation, we experience some technical difficulties, and so we need to convert to open surgery. Therefore, patients should be aware that while we may plan to do the operation laparoscopically, they may end up having an open cut to the tummy due to some of the risks or complications that I have described.




If you require laparoscopic surgery to treat or diagnose a gynaecological issue and wish schedule a consultation with Mr Amu, visit his Top Doctors profile today.