Until recently, surgical treatment of disorders of organs in the abdominal cavity in women used laparotomy, i.e. incision of abdominal wall layers in suprapubic area or vertically above the umbilicus. New surgical techniques being the effect of technological advances are based on the principle of minimally invasive intervention into a human body during a surgical procedure. Such possibility is provided by laparoscopy which belongs among endoscopic surgical techniques.

Laparoscopy in literal translation means the method of viewing (observing) the inside of the abdominal cavity. The history of this method goes back to the end of nineteenth century but only in the last two decades of the last century it gained importance in the process of diagnosis of various conditions located in abdominal cavity. Normally, we can distinguish diagnostic and surgical laparoscopy. Diagnostic laparoscopy is used to diagnose acute and chronic abdominal pain, abdominal tumors, gallbladder diseases or during verification procedures to determine the stage of cancer disease. Surgical laparoscopy, thanks to the use of modern medical technologies, is also gaining importance in surgical treatment. Laparoscopic surgery means performing many surgical and gynecological interventions with the use of a complex technical apparatus which allows to view the organs in the abdominal cavity optically magnified, and with the use of special micro-tools incise, resect and remove fragments of affected tissues or organs. A laparoscopic procedure allows the surgeon not only to diagnose the disease but at the same time to introduce appropriate surgical treatment.

Laparoscopy in gynecology

In gynecology, laparoscopy is applied mainly because it is less traumatic in comparison with conventional surgical techniques. Many pathological conditions do not require large operative field in order to make proper diagnosis. Laparoscopic examination allows to assess the structure, condition and location of internal organs, in particular reproductive organs within the lesser pelvis thus allowing the identification of abnormalities. Laparoscopy is most often used in the treatment of ovarian cysts, in infertility, diagnosis and treatment of endometriosis and ectopic pregnancy. It is usually applied in the situations where the previous diagnostic exams in a patient demonstrated: infertility, tumor-like ovarian lesion, developmental defects of reproductive organs, tubal ectopic pregnancy, uterine fibroid, intra-abdominal and peritubal adhesions, as well as in case of confirmed salpingitis and other pathological symptoms including unexplained pain in lower abdomen or abnormal uterine bleeding.
Laparoscopic surgeries are minimally invasive and rarely involve any complications. High safety of this method is ensured to a large extent by the modern equipment used in laparoscopy and highly qualified medical staff undertaking the treatment.

How is laparoscopic surgery performed?

Laparoscopy is a surgical procedure carried out under general anesthesia. Special electrosurgical micro-tools used in laparoscopic surgeries allow to cut, resect and remove fragments of affected tissues or organs.

Simplified diagram of laparoscopy

The basic tool used in this technique is a vision system, i.e. an optical telescope with connected micro camera and optical fiber cable – explains Marek Neuberg, MD, Head of the Department of Surgery and Gynecology at INVICTA Fertility Clinic. – The optical telescope is introduced to the abdominal cavity through the navel; earlier a vertical incision 5 to 10 mm long is made in the navel’s bottom. For this, a special cannula is used which is called trocar. In the beginning, however, using the so-called Veress needle, the abdominal cavity is insufflated with carbon dioxide which elevates the abdominal wall layers and creates space among various internal organs. Through small, 5 mm incisions in the skin of the abdomen, micro-tools are inserted into the abdominal cavity by means of the trocar. The camera transmits the image from inside of the abdominal cavity to the monitor. The operator, looking at the display, views individual organs inside the abdominal cavity and using micro-tools operates on affected organs – explains doctor Neuberg. During a laparoscopic surgery, an appropriate apparatus monitors the work of the vision camera, regulating the operating lights of the operative field as well as the pressure and low of carbon dioxide which fills in the abdominal cavity. After the completed surgery, carbon dioxide is released from the abdominal cavity and the previously made incisions are closed with single sutures

Advantages of laparoscopy

Laparoscopic surgeries are in the first place surgical interventions which do not require the opening of the abdominal wall layers. During the laparoscopy, only small, few millimeter skin incisions are made with extreme precision. Optical magnification achieved during laparoscopy allows to operate on affected organs with extreme precision while the applied electrosurgical tools allow to minimize the blood loss during the surgery. After laparoscopic operations patients recover very quickly and there are definitely less complications related to the surgical trauma. The main advantage of laparoscopic surgeries is fast healing of wounds and small scarring which is particularly important for young women. Laparoscopy is also a perfect diagnostic tool in case of infertility. It detects anatomical abnormalities related to reproductive pathologies; it is also the most accurate method of checking the patency of fallopian tubes.
Currently, most gynecological surgeries can be carried out using the laparoscopic technique. In surgery, it is most commonly applied for gallbladder resection, while in gynecology – for removing ovarian cysts, adnexal tumors, uterine fibroids and for treating endometriosis and ectopic pregnancy. Total laparoscopic hysterectomy is also performed.

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Published: 5 November 2015 Updated: 4 April 2017