KOCHI: In 1988, Dr Harry Reich in Pennsylvania first did a laparoscopic hysterectomy. Since then, immense advancement has taken place in laparoscopy for gynecological diseases.
What exactly is endoscope/laparoscopic surgery?
Endoscopy is a procedure used to visualise the interior of a hollow organ or cavity of the body by a camera. When it is for visualisation of the lungs it is called a bronchoscopy, for visualisation of the abdominal organs, it is called laparoscopy. The name varies according to the site of the body where the camera is inserted.
When an intra-abdominal surgery is done by the use of a laparoscope it is called laparoscopic surgery. In laparoscopic surgery, a camera is introduced into the abdomen via a small 10mm incision. Then carbon dioxide gas is connected into the abdomen as a distension media to get a good visualisation of the abdominal organs. The procedure is performed using long slender instruments of <5mm in diameter.
Why laparoscopic surgery?
One of the most common fears of patients is the pain following surgery. Pain perception for every individual is via the somatic nerves. The visceral nerves do not perceive pain unless they are stretched or have an infection. That is exactly why laparoscopic surgery is preferred due to the minimally invasive skin and abdominal muscle incision. This also helps in early return to work and routine activities such as the body’s voluntary movements are innervated by somatic nerves which are less damaged in laparoscopic surgery.
An incision wound will take time to heal and repair. The larger the incision, the greater the healing time. Furthermore, compared to open surgery, the manipulation of tissues for proper visualisation is much lesser in laparoscopic surgery thus leading to little chance of internal organs(which are mobile) being stuck together.
Blood loss in laparoscopic surgery is mild due to minimal incision. All these advantages lead to reduced morbidity of the patient, faster postoperative recovery, and a short hospital stay.Laparoscopy is a boon for the surgeon as tissue visualization is under magnification and advanced instrumentation helps in better tissue dissection. A revolution in surgery benefitting the patient as well as the surgeon occurred after the launch of laparoscopy.
When to seek a gynaecological consultation?
The majority of the gynaecological issues can be traced by a woman’s menstrual pattern-whether her cycles are regular/not, if she has heavy/scanty bleeding or if there is painful menstruation that affects her daily activities.
In Kerala, there is a higher incidence of endometriosis. Endometriosis is a condition in which the tissue of the uterine cavity known as the endometrium is found outside the uterus. The pain women endure in such cases is sometimes unbearable and most wistfully it happens to be very common in young women. If they have to undergo a surgical treatment for endometriosis the dictum is ‘the first surgery is the best as it can reduce the chances of recurrence.
The author is a senior laparoscopic surgeon/gynaecologist, Sunrise Hospital, Kochi. Views expressed are his own.