the laparoscopic technique allows physician intervening using a special instrument that enters the abdomen through small incisions, less than one cm, rather than through large surgical incisions. For this reason, the laparoscopic surgical technique is considered a much less invasive than the traditional surgery.
WHAT IS A GYNECOLOGICAL LAPAROSCOPY PROCEDURE PERFORMED?
The gynecological laparoscopy is performed by making an incision near the navel through which the gas is introduced (carbon dioxide ) using a special needle; this is to expand and stretch the abdominal cavity allowing a better view and a wider surgical space. In the same incision it is also introduced the laparoscope , a special optical instrument, which examines the inside of the abdominal cavity and pelvis using a light source and a video system (camera, monitor, VCR). In this way, you can get a good view of all the organs concerned.
They are then carried out two more small incisions, always in the abdomen, through which passing the surgical instruments (electrosurgery device, needles, forceps, scissors, suction devices, etc.) that will operate with the help of the video system described above. In some cases, it may be necessary to introduce an instrument into the vagina, called manipulator, which will have to move the uterus as needed during surgery. At the end of the surgery, the instrument is extracted trying to facilitate the escape of the gas introduced earlier. Finally, the small incisions are sutured.
HOW LONG DOES THE LAPAROSCOPIC PROCEDURE LAST?
The duration of a the surgical procedure that uses the laparoscopic technique varies depending on the complexity of the operation (from a minimum of 15 to 30 minutes, in cases in which the procedure has to be performed, to a maximum of two hours in the most difficult cases). The duration should therefore not be underestimated, but much less than all of the benefits arising from the use of this technique.
WHAT TYPE OF ANESTHESIA IS USED FOR A LAPAROSCOPY?
Laparoscopy always involves general anesthesia. The surgery is done by blowing carbon dioxide into the abdomen. The introduction of the gas, which serves for improving the visibility in the area on which it is supposed to intervene, exerts a pressure which in normal conditions would prevent expansion of the lungs. For this reason, in the course of general anesthesia, it is necessary to compensate for the intra-abdominal pressure with ventilator anesthesia. Also during the surgery, the patient assumes an upside down position (Trendelenburg position), that during longer duration surgeries would be unwelcome. In this case, however, the laparoscopic surgery, due to its lower invasiveness, permits lighter forms of anesthesia resulting in a better post-surgical prognosis.
WHY PERFORMING THE LAPAROSCOPY IN THE CASE OF INFERTILITY OR TOTAL STERILITY?
In the diagnostic workup of infertility, laparoscopic surgery can be a must. Only through laparoscopy, the pysician can record exactly the state of the pelvic organs, the presence of adhesions that alter the relation between tubes and ovary and the presence of endometriosis. During the surgery, it is also possible to evaluate the presence of adhesions, the state of the mucosa of the pavilion an , especially, the patency of the fallopian tubes or their opening. To this purpose, Chromesalpingoscopy is often performed using a dye that assesses its proper passage through the tube with great precision. Physicians also make use of the laparoscopy to arrive at a diagnosis in cases of clinical conditions (infertility, chronic pelvic pain, etc.) do not whose causes are not explained with the traditional survey methods (laboratory tests, ultrasound, etc.). Thanks to laparoscopy, it may be possible instead to arrive at an accurate diagnosis and contextually intervene when necessary on the diseases highlighted (endometriosis, adhesions, etc.).
WHY PERFORMING THE LAPAROSCOPY WHEN THERE ARE OVARIAN CYSTS AND TUBAL INFLAMATION?
It's common that the patients who suffer from chronic pelvic pain or infertility have pelvic adhesions. These are nothing more than fibrous tissues that let abdominal and pelvic organs adhering to each other. Through laparoscopy, the pelvis can be thoroughly released obtaining satisfactory results in most cases. In addition, the laparoscopic surgery, being less invasive than the traditional laparotomy, greatly reduces the chance that new adhesions reform in time.
WHY PERFORMING THE LAPAROSCOPY IN THE CASE OF OVARIAN OR TUBAL CYSTS?
Through the laparoscopic surgery, it is possible to eliminate undamaged cysts of any shape and size, after suction, hollowing out the cyst capsule and preserving the tissue of the ovaries.
The adnexal pathologies include the pyosalpinx (the presence of pus in the fallopian tube caused by inflammation) and hydrosalpinx (the presence of serous exudate in the lumen of the tube, caused by stenosis or occlusion of the organ end).
WHY PERFORMING THE LAPAROSCOPY IN THE CASE OF ENDOMETRIOSIS?
In case of endometriosis, it is almost always required that the diagnosis is made or confirmed through the laparoscopy. The laparoscopic surgery will vary depending on the extent and development of the disease. When endometriosis is not severe, you should consider the use of laser vaporization or diathermy (also known as acid burn) of endometriosis. Sometimes it may also be necessary to remove the adhesions that bind the pelvic organs. Frequently laparoscopy has the purpose of removing ovarian endometriotic cysts making sometimes inevitable the removal of the ovary.
WHY PERFORMING THE LAPAROSCOPY WHEN THERE ARE OVARIAN CYSTS AND TUBAL INFLAMATION?
Undergo the gynecological laparoscopy in cases of ectopic pregnancy, by the eighth to ninth week of pregnancy, can often save the tuba involved with a self-check of its functions. In the case in which the tuba is seriously damaged, it may be required for its removal (salpingectomy).
WHY PERFORMING THE LAPAROSCOPY WHEN THERE ARE UTERINE MYOMAS?
Laparoscopy allows you to remove intramuraluterine or subserosal development fibroids, even of considerable size (8-10 cm in diameter). These are removed after breaking them through the "Morcellator", an instrument whose dimensions make it necessary to make slightly larger incisions than usual ones (2 cm maximum).
WHY PERFORMING THE HYSTERECTOMY VIA THE LAPAROSCOPY?
Through laparoscopy today you can also undergo the hysterectomy, or removal of the uterus. The mode of execution may vary depending on the case, being possible sometimes to keep the neck of the uterus and the ovaries according to the needs of the patient.
WHY PERFORMING THE LAPAROSCOPY WHEN THERE IS CHRONIC PELVIC PAIN?
Young women in full ovarian activity can frequently suffer from the onset of chronic pelvic pain. The causes of the pain can be many and may involve: a) the genital apparatus b) the urinary tract c) the digestive system d) and the peripheral nervous system e) the internal muscles of the pelvis.
So there are organic, functional or anatomic conditions and causes of psychogenic or autonomic nature , then mostly psychological in nature. If the causes are organic to specific pelvic pain, they may be associated with other symptoms that anamnestically help to orient the investigations on the apparatus or the organ that gives rise to pain. While trying to investigate the causes of the chronic pelvic pain, the physical symptomatology is definitely very important (gynecological examination, abdomen examination and orthopedic and neurological evaluation in case you believe that pain is related to disorders of the peripheral nervous system, the spine or root). Often, however, these steps are not enough and it becomes necessary to perform diagnostic tests through laparoscopic surgery.
It was found that the causes that are most frequently due to chronic pelvic pain are as follows:
pelvic inflammatory disease
genital prolapse and retroversion of the uterus
postsurgical pelvic adhesions or post-inflammatory syndromes
polycystic ovary syndrome
primary dysmenorrhea and pain associated with ovulation
benign or malignant tumors
painful complications after radiation therapy for gynecologic malignancies
Pain is defined as chronic when it lasts for more than 3 to 6 months. In many cases it is manifested as a dull ache that is accentuated by the occurrence of certain conditions (sexual intercourse, menstruation).
WHAT ARE THE REAL BENEFITS OF THE GYNECOLOGICAL LAPAROSCOPY?
Compared to traditional surgery, laparoscopy has numerous advantages.
Surgical wounds of the abdominal wall, as compared to those produced by traditional surgery, are significantly reduced in size, and this entails an advantage in terms of reduced trauma suffered by the abdominal wall and in terms of aesthetics. Thanks also to the video display system, the ability to see the pelvic organs has improved, compared to how it used to be during traditional surgery. Failure to open the abdomen involves a trauma of the organs in the abdominal cavity, significantly reduced and resulting in a better post-surgical course and a faster recovery of the functionality of the intestine.
This results in the reduction of the hospital stay and a quicker return to work and social activities.
ARE THERE ANY RISKS AND/OR COMPLICATIONS RELATED TO LAPAROSCOPIC SURGERY?
As with all medical and surgical procedures, laparoscopy may also involve some risks. Bleeding or lesions of the abdominal organs, such as the intestinal tract, may occur. The greater or lesser likelihood of complications is closely related to the complexity of the surgery; the risk is less, for example, when performing a diagnostic laparoscopy rather than in the case where action is taken during a severe case of endometriosis.
The percentages of risk are also connected to the characteristics of the patient. If, for example, there is a marked obesity, performing laparoscopy is, in most cases, impossible.
More difficulties and complications are therefore more likely to be put in relation to the patient’s medical history. In the case that a woman has in fact already undergone abdominal surgery, there could be adhesions in the abdominal cavity creating a complex situation. Therefore, in the presence of technical difficulties or complications, it may become necessary, in some cases, to resort to a surgical laparotomy and then perform traditional surgery on the abdomen.
In the hours following the surgery, the woman does not have to worry about the presence of shoulder pain caused by the gas introduced into the abdomen to make her relaxing. This will disappear spontaneously within 24 hours. In some cases, you may use endopelvic drainageto avoid this unpleasant side-effect. Another possible consequence is the appearance, in the days following the surgery, of some blood loss from the vagina. This can be caused by the use of the "manipulator", the instrument that is used to mobilize the uterus during surgery, but there is no cause for particular concern, because the organ will spontaneously return to be normal within a few days.