Laparoscopy has become a major surgical tool for gynecologic and non-gynecologic procedures, and has become one of the most common surgical procedures throughout the world.
Laparoscopy has been proven to be less expensive and safer than laparotomy. It is preferred for gynecological procedures including treating endometriosis, ovarian cystectomy, hysterectomy, sacral culpopexy, treating cancers and removing ectopic pregnancies, with more uses being discovered as the technique evolves. Laparoscopy continues to improve with significant technological advances including improved instruments, better cameras and the use of robotically assisted procedures that led the way for single-port laparoscopy.
Laparoscopy was first used in the early 1900s when German surgeon Dr. George Kelling attempted to use air for pneumoperitoneum to stop intra-abdominal bleeding, and was first performed on dogs. In the 1950s, a quartz light rod was added to the larascope, which increased lighting during the procedure and proved a safer lighting system and led the way for fiber optic technology use. Solid state video cameras were introduced to laparoscopy in 1982 and allowed both laparascopists and assistants to view what was being performed, leading to laparoscopy becoming a preferred surgical approach for many surgeons, especially gynecologists.
Though it is used for many major surgeries, laparoscopic procedures are similar to minor surgeries that allow patients to feel less pain, recover faster and requires only small incisions. Laparoscopy remains an intra-abdominal procedure and shares many similar risks to laparotomy. The most common risks include infection and injury. Although there are still great risks with more major procedures, such as hysterectomy, laparoscopy still reduces postoperative pain and morbidity for patients.
Like all procedures, laparoscopy has associated risks. Common risks include injury to bowel, bladder or major blood vessels, intravascular insufflation, blood loss and increased anesthesia risks. Although its ideal role in gynecology has yet to be determined, laparoscopy is becoming a standard approach for many procedures.
Common uses for laparoscopy include:
- Diagnostics – Laparoscopic procedures help doctors better assess the causes for pain in patients by allowing them to observe the pelvic organs and obtain a biopsy specimen. This is often performed under general anesthesia.
- Endometriosis – Commonly used for diagnosing and treating endometriosis, laparoscopic Power Instruments can be used to resect or ablate endometriotic lesions and are proven to help increase fertility and decrease pain.
- Ectopic Pregnancy – Laparoscopy is the preferred surgical approach to remove the embryo and gestational sac for ectopic pregnancies, commonly using Power Instruments such as ultrasonic scalpels and bipolar electrosurgery.
- Tubal Sterilization – Similar to diagnostic laparoscopy, tubal sterilization uses bipolar electrosurgery, clips or silastic bands to occlude the tubes 2-3cm from the cornua, resulting in only 1-3% pregnancy rate after 10 years.
- Lysis of Adhesion – Adhesions are a common attributing factor to infertility, andoften form from prior infections. Adhesions are lysed by Power Instruments and the tools used depend on the location and severity of the adhesion. Unfortunately, laparoscopy for lysis of adhesion has not been proven to fully eliminate pain and chances of pregnancy after lysis of adhesion is still relatively low.
- Ovarian Cysts – Methods for ovarian cystectomy vary depending on the size and malignancy of the cyst(s). Often, surgeons will attempt to remove the cyst intact by dissecting it and removing it, sending the walls to be frozen and tested for malignancy. Laparotomy is often used for malignant cysts and more complicated cyst removals, while laparoscopy is preferred for simpler procedures.
- Oophorectomy – Ovary removal is common for postmenopausal women with persistent cysts, tubal pregnancies and women with large hydrosalpinx with adhesions. The ovary is often removed either using a bag to remove the tissue or colpotomy, which requires an incision in the vagina.
- Myomectomy – Myomectomy is preferred for women who wish to preserve fertility. The fibroids are often removed by colpotomy or morcellation, which divides and removes the tissues. Laparoscopic procedures make the process fasterm, but have not yet been proved to be a better option than laparotomy.
- Hysterectomy – Laparoscopy can help assess feasibility of vaginal hysterectomy and perform some or all of the actual removal of the uterus. Three common procedures are vaginal hysterectomy, laparoscopic hysterectomy and supracervical hysterectomy. All are standard procedures, but each have their own risks.
- Oncologic Procedures – Robotis laparoscopic surgery has changed the approach to gynecologic cancer treatment because it allows surgeons to have a 3D, high-definition magnification of the topography of the patient’s body. Laparoscopy can be used for various oncologic procedures, but each procedure comes with its own risks.