MINIMAL ACCESS (KEYHOLE) SURGERY IN GYNAECOLOGICAL PROBLEMS

Minimal access surgery is a newer treatment modality in which surgeries for gynaecological problems are performed by almost invisible, micro cuts on the abdomen. This is of two types, laparoscopic surgery and hysteroscopic surgery.

 Laparoscopic surgery is performed using 2 or 3 small cuts on the abdomen, followed by inserting microsurgical instruments to perform surgery. Even major operations like removal of uterus, removal of fibroids, removal of ovarian cysts and many other surgeries can be easily performed by this route. This has almost completely replaced the older “Conventional” surgery, which used a large cut on the abdomen to see and operate on the internal organs.

There are a number of obvious advantages of laparoscopic over older conventional surgery:

1. As the scars are very small compared to open surgery, pain after surgery is much lesser
2. Smaller scars mean better cosmetic results.
3. Laparoscopy offers the surgeon a magnified view of the organs, up to 20 times or more. This obviously means more precise surgery
4. Significantly less blood loss during surgery
5. Early discharge from hospital (1 or 2 days). Typically, any patient undergoing open surgery will have to wait in the hospital for at least 4 to 5 days.
6. Early return to normal activity and work (4 to 5 days). In conventional surgery, rest at home is recommended for about 15 days.

Hysteroscopic Surgery is performed using a telescope to look within the uterus, through the vagina. The inner lining of the uterus, called the endometrium is checked. This is precisely the area from where menstrual bleeding takes place. This is also the area where the pregnancy takes roots and grows. Hence, plenty of defects can be identified in patients of abnormal menstrual bleeding, infertility and abortions, which can be completely missed even by sonography or CT scan/ MRI. These defects include fibroids, polyps, uterine synechiae and abnormalities of uterine shape. This is a zero scar procedure, and patients are sent home within 4 to 6 hours of surgery.

Hysteroscopy is the gold standard test for patients suffering from Irregular/ heavy/ scanty menstrual bleeding, Infertility, repeated abortions & bleeding in older age and after menopause.

Dr Sanket Pisat  MS, DNB , FICOG

Consultant Gynaec Minimal Access Surgeon (Laparoscopy / Hysteroscopy)