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The Everywoman Cliniq

Endoscopic surgery

Keyhole or buttonhole surgery

Laparoscopic Surgery – The Keyhole Magic

Gone are the days when surgery meant a major operation with big cuts and stitches and long hospital stay with prolonged rest and recovery time. With the advent of ‘Keyhole’ or ‘buttonhole’ surgery (Laparoscopy) many of the surgeries for women which required major cuts on the stomach are now done with 2-3 cuts of ½ to 1 cm each.

Fibroids are usually non cancerous solid tumours in the womb (uterus). These can cause heavy irregular menses, pain, pressure and heaviness of the lower abdomen in many cases. These tumours are very common and are seen even in young women. These fibroids unfortunately cannot be treated with medicines but have to be removed surgically if they are causing problems. Laparoscopic surgery can remove even large fibroids with minimal cuts on the stomach wall. The entire surgery is done by watching the procedure on a television screen and operating with a camera in the abdomen. The large fibroids are made into small pieces by means of a special machine called the morcellator and so can be removed through a small opening.

Patients who are older and have fibroids or problem of heavy bleeding during periods or some other reason to remove the womb can also be treated by laparoscopic surgery. The womb (uterus) can be removed by this procedure. The patient’s hospitalization is less and recovery is very fast. Prolonged rest and absence from work is not needed.

Ovarian cysts are common and can occur in any age group. They may be simple cysts, endometriosis or dermoid cysts where water, blood or thick pus like material can fill in the ovary. These cysts are best treated by laparoscopic surgery. Endometriosis is a major problem in young women where dark, thick blood accumulates in the ovary or around the womb and causes pain and often inability to conceive. It damages the tubes and ovaries and can cause the intestines to stick together. This problem can also be treated by keyhole surgery.

Infertility (inability to become pregnant) is on the rise and often one of the necessary investigations is to put a camera through the belly button into the pelvis and check to see if the tubes are open and if the uterus and ovaries are normal. If any problem is detected it can be treated at the same time. Keyhole surgery is here to stay. More and more operations are now being done by this method though there is still a role for traditional open surgery in certain cases.


Office Hysteroscopy

Hysteroscopy uses a hysteroscope, which is a thin telescope that is inserted through the cervix into the uterus. Modern hysteroscopes are so thin that they can fit through the cervix with minimal or no dilation. Although hysteroscopy dates back to 1869, gynecologists were slow to adopt hysteroscopy. Because the inside of the uterus is a potential cavity, like a collapsed airdome, it is necessary to fill (distend) it with either a liquid or a gas (carbon dioxide) in order to see. Diagnostic hysteroscopy and simple operative hysteroscopy can usually be done in an office setting. More complex operative hysteroscopy procedures are done in an operating room setting.


Operative Hysteroscopy

Operative Hysteroscopy is performed under general anesthesia. This will allow the physician to both diagnose and treat most findings, which are encountered at the time of the procedure. The Operative Hysteroscope has ports, which allow the physician to insert operating tools, such as, scissors, cautery devices or a laser fiber. These may be used to resect or cauterize specific abnormalities under direct visualization. The Hysteroscope is also valuable in treating some forms of tubal occlusion. Many patients with a blockage in the fallopian tube may have an obstruction at the junction between the uterus and fallopian tube. The Hysteroscope is used to pass a small catheter through this contracted area under direct visualization. Occasionally, scar tissue can be disrupted and allow passage of sperm as the result of the procedure. A physician will be able to evaluate the cervical canal, the contour of the uterus, and the quality of the endometrial lining. The tubal ostia are the openings of the fallopian tube into the uterine cavity. They should be easily seen with the hysteroscope


Diagnostic Laparoscopy

A diagnostic laparoscopy is a technique used by surgeons to obtain information about the inside of your abdomen without making a large incision. Through a few small incisions, the surgeon inflates the abdomen with gas (carbon dioxide) to enlarge the size of the viewing area. He or she then inserts a laparoscope or small camera which projects images of the abdomen onto a high resolution television screen. By mobilizing the camera, the surgeon can have a very thorough look through your abdomen without the pain and recovery of a larger incision. In most cases, this procedure provides the surgeon with more information about your condition than if routine tests were used.


Operative Laparoscopy

Operative laparoscopy is performed for many different conditions. These may include Infertility treatment-used to remove endometriosis, cut adhesions (scar tissue) or open closed fallopian tubes
Pelvic Pain
Ovarian Cysts--Remove the cysts, or drain them
Remove small fibroid tumors
Sterilization procedures--tubal ligation (getting your tubes tied)
Treating ectopic pregnancies--pregnancy in the fallopian tube
Sometimes a Laser is attached to the laparoscope to help in the removal of endometriosis or to remove adhesions or cut tissue.
We use the latest laser technology (Coherent 5000L laser) which was specially designed for this purpose. Sometimes, however the laser does not work as well as other techniques, so ask your doctor.