Laparoscopic surgery in gynaecology is a blessing for today’s patients
Laparoscopic surgery, also known as keyhole surgery or minimally invasive surgery, is a newly developed surgical approach where operations are performed through small incisions — usually 0.5 to1.5cm — with the help of operative video-laparoscope. This is a revolutionary advancement in surgical techniques and is gradually replacing open surgery.
Last century had seen two major breakthroughs in medical science, which have had far-reaching impact on medical practice, and both were facilitated by gynecologists.
First of them is the ultrasound scan used by a submarine during World War II. The old machine was bought and installed in Glasgow Royal infirmary in the mid-1960s. Professor Ian Donald started using it on his obstetric patients.
Around the same time, laparoscopes were taken into clinical practice by gynaecologists like Patrick Steptoe in United Kingdom at Royal Oldham Hospital and Nezhat and colleagues in America. Royal Oldham is the same hospital where world’s first in-vitro fertilisation (IVF) pregnancy was conceived and Louis Brown was born.
Patrick Steptoe was a gynaecologist working at the Royal Oldham Hospital, a cottage hospital in outskirts of Manchester, and Robert Edward was a scientist working at Cambridge, the well-known scientific centre of excellence. Very few people know why the world’s first IVF baby was conceived and born in a rather unknown small cottage hospital.
At that time, gametes recovery for IVF was only possible with help of laparoscopes. Steptoe had developed the skill and Edward had to travel to Manchester from Cambridge to get help from the laparoscopist. In other words, The Royal Oldham Hospital was the first centre of excellence in lipotropic surgery. Steptoe and Edwards were awarded Nobel Prize for their achievement in the field of human fertility.
I worked in the department of gynecology at Royal Oldham Hospital and was lead infertility consultant from 2002 to 2017, where I practised advance laparoscopic gynaecological surgery. I was the mentor for advanced laparoscopic surgical training in gynecology. When Royal Oldham Hospital was recognised as a centre for endometriosis. I was one of the team members.
I joined Zulekha Hospital Dubai in March 2017, where we are off-ering the full range of gynaecological laparoscopic surgeries. Facilities include hystrectomies (removal of womb), oophorectomies (removal of ovaries), salpingectomies (removal of tubes), myomectomies (removal of fibroids), resection of advance endometriosis (removal of endometriosis), tubal surgery (opening, mobilisation and reanastomosis of fallopian tubes) for infertility treatment and adhesolysis (freeing of stuck tissues and organs for pelvic pain and or infertility).
We also offer ovarian drilling for treatment of PCOS and infertility, sacrocolpopexy for vault prolaps, surgical treatment of ectopic pregnancy, dye test for infertility investigation, hyderosalpingectomy (removal of water-filled tubes), clipping of hydrosprings (blocking of water filled tubes before IVF treatment and diagnostic laparoscopy for different reasons).
Rather than a minimum 15-20 cm incision for traditional (open) myomectomy or hysterectomy, three incisions of 0.5–1.0 cm are used at different points of the abdomen, hence known as keyhole surgery.
The laparoscopic approach is meant to minimise post-operative pain and achieve speedy recovery. It has proven to be beneficial in reducing post-operative morbidities such as incisional hernia, wound infections. The laparoscopic approach is safe when applied to complex surgical procedures like for advanced endometriosis, removal of large and multiple fibroids and hysterectomies, specially in obese patients.
There are many benefits to the patient with laparoscopic surgery compared to an open procedure:
> Key hole surgery is performed through smaller incisions which results in less post-operative scarring, less pain and reduced recovery time which results in shorter hospital stay, often with a same-day discharge.
> Enhanced recovery leads to a faster return to work and everyday life.
> Because of less pain, patients need less post-operative pain medication.
> Closed surgery results in reduced exposure of internal organs to possible external contaminants, thereby reducing the risk of acquiring infections.
> There are increasing indications for laparoscopic surgery in gynaecological emergencies like treatment of ectopic pregnancy, bleeding corpus luteal cyst, torsion of cyst or ovary, acute pelvic infection and for drainage of pyosalpings, repair of uterine perforation, treatment of caesarean scar pregnancy etc. Disadvantages of laparoscopy While laparoscopic surgery is clearly advantageous in terms of patient outcomes in expert hands, the procedure has a steep learning curve and may encounter more complication risks in the hands of less experienced surgeons. (Dr Zulqarnain Kazim Anjum is a consultant gynaecologist at Zulekha Hospital in Dubai) (This article is sponsored by the advertiser)