What is keyhole surgery?
Understanding what laparoscopic surgery means.
A MAJORITY of women in their lifetime would have undergone some form of surgery. Whether it’s a minor or major surgery, it is still a nightmare to go through.
By the age of 60, one in every three women would have undergone a hysterectomy (surgery to remove the womb) for various reasons.
Traditionally, gynaecological surgery (involving a female’s reproductive organs) are associated with big skin incisions, painful recovery, and a longer time to get back to normal.
Longer recovery means loss of quality time with family, friends or at work. For some, it means loss of income too.
Gynaecological surgery has evolved so much that the traditional phrase “big skin incisions, painful and slow recovery” has been replaced with “small incisions, nearly painless and out of hospital the next day”.
The reason for this change is laparoscopic, or keyhole, surgery.
Laparoscopic surgery has been around since the 1930s, but many women do not know about it.
Laparoscopy generally requires between two to four small “keyhole” incisions on the abdomen (tummy).
Through these small holes, instruments such as a laparoscope (a thin telescope-like instrument), scissors and grasper are introduced to perform surgery.
The latest development is 3D laparoscopic surgery, where the surgery is done with a 3D screen.
Currently, many gynaecological surgeries can be done laparoscopically. Even some gynaecological cancer surgeries are done this way.
The commonly-performed gynaecological laparoscopic surgeries include: hysterectomy; myomectomy (removal of a fibroid from the womb); cystectomy (removal of a cyst from the ovary); diagnostic laparoscopy (surgery to find a diagnosis, such as for pelvic pain, or part of treatment for infertility); tubal ligation (permanent sterilisation for females); fertility-related surgeries (required to help a woman conceive); endometriosis; correcting prolapse of the uterus/womb; and cancer surgeries (womb and cervix).
Here are some common questions – and answers – about laparoscopic surgery:
How can surgery be done through a small hole? Are you kidding me?
The surgery is performed by utilising very specialised laparoscopic instruments, which are thin and small. The laparoscope helps the surgeon see the internal organs in a magnified view projected on a TV screen. The latest technology is a 3D screen that improves the clarity of images.
How will my surgical wound look like?
Your abdomen will usually have between two and four small cuts. The cuts are normally no longer than 1cm, typically between 0.5cm and 1cm. The wound normally heals very well and the scars are not very visible in the majority of cases.
Is there any way to do surgery with a smaller scar on my tummy?
Yes, there is a way, and it’s called Single Incision Laparoscopic Surgery, where only one cut about 2cm long is made at the umbilicus. Once it heals, you don’t even see the scar as it is within your belly button.
However, it is not suitable for all types of surgery.
Why is there less pain in laparoscopy?
In traditional surgery (laparotomy), big skin incisions are made in order to gain access to internal organs, while in laparoscopy, only tiny punctures are made. Thus, post-surgical pain as a result of wound healing is more severe in traditional surgery than in laparoscopy. In the majority of laparoscopies, mild pain relief is sufficient.
How early can I walk after the surgery? On the same day if possible, because there is less post-surgical pain. You should be back on your feet the next day, getting ready to go home, but this depends on the type of surgery done.
For certain types of surgery, the patient can go home on the same day after the surgery! Generally, a one-night stay after surgery can be expected.
How will I know if laparoscopy or conventional surgery is better for me?
Laparoscopic surgery can reduce the chances of adhesion (scar tissues inside the abdomen) from forming.
In laparoscopy, only fine instruments are used to perform the surgery, whereas in traditional surgery, the surgeon places his/her whole hand inside the abdomen. Therefore, traditional surgery has a higher likelihood of adhesion formation.
This is especially important if you want to conceive, because adhesions in the area of the Fallopian tubes and ovaries may lead to difficulty conceiving later on.
The method of surgery is also dependent on the underlying condition that is being treated.
Is laparoscopic surgery safe? Any surgery, however small it is, has its risks. In laparoscopy, the magnified vision helps the surgeon see the internal organs better.
This can lead to reduced bleeding. Moreover, infection risk can be reduced because the internal organs are not exposed to room air. Expert use of the surgical tools may lead to a better surgical outcome.
In short, the skill of the laparoscopic surgeon can determine the outcome of the surgery.
Quicker return to mobility also reduces the risk of deep vein thrombosis (DVT), which is the formation of blood clots in your blood vessels due to prolonged immobility.
If you need a gynaecological surgery in the future, ask your gynaecologist about laparoscopic surgery.
Dr Agilan Arjunan is an obstetrician and gynaecologist, and fertility specialist. For further information, e-mail starhealth@ thestar.com.my.