Laparoscopy is a surgical technique which allows surgeons to perform advanced procedures through several small incisions in the abdomen. The first simple laparoscopic procedures were performed in 1980’s. Thanks to better instrumentation and training, the technique has evolved so even complicated procedures can be preformed laparoscopically. Patients are fully asleep for any laparoscopic surgery and typically 3-4 incisions are placed in the abdominal wall. Incision in the umbilicus is 10 mm (approx. ½ of an inch) and is used for a camera. Three lower incisions are 5 to 10 mm (1/5 – ½ of an inch), depending on the procedure, and are placed in the lower abdomen.
Surgery
Surgery is performed with a camera placed in the belly button and instruments placed in the remaining incisions. Gynecology procedures commonly performed with laparoscopy are: removal of the ovarian cyst, removal of the ovary, removal of the uterus with or without the ovaries, removal of fibroids, removal of endometriosis. The surgeon’s ability to perform some of the more difficult laparoscopic procedures depends on training and absolute dedication to minimally invasive surgery. Some of the more complicated laparoscopic procedures performed in our practice are resection of extensive endometriosis involving bowel, urethras and bladder, removing adhesions (scar tissue) and presacral neurectomy (cutting nerves which conduct pain sensation from the uterus).
Robotic Surgery
Robotic surgery, more accurately called robotic assisted laparoscopic surgery, is a surgical technique allowing even the most complicated pelvic procedures to be performed through several small incisions. It is a better, more accurate way to perform laparoscopic procedures. In traditional laparoscopy, after instruments are placed through small incisions in the abdomen, surgeons directly hold those instruments to perform the surgery. In robotic assisted laparoscopy, those instruments are connected to the da Vinci surgical robot and operated by a surgeon through movements of joysticks at the surgeon’s console. Using a surgical robot allows for a much greater range of motion of the instruments and a three dimensional vision of the area of surgery. This leads to greater precision, better suturing, fewer blood loss and lesser pain after surgery. All gynecologic procedures that are performed laparoscopically can be preformed with the da Vinci surgical robot. Additionally, procedures which were difficult to do with traditional laparoscopy, such as removal of multiple large fibroids, are much easier with robotic assistance. Robotic instruments are 8 mm, which are slightly larger than laparoscopic instruments and are usually placed higher, but the overall cosmetic effect is still excellent. This is most likely due to the fact that movements of instruments by the robot is more gentle than by the human hand, therefore there is less bruising and stretching of the skin around laparoscopic ports.
Advantages
Advantages of laparoscopic surgery are faster recovery and lack of a large scar on the abdomen. Depending on the procedure, patients leave the hospital the same day or the next morning after surgery. They also return to work and daily activities faster and have considerably fewer restrictions in postoperative period. Another advantage of laparoscopy is that the camera provides superior view as compared to open surgery and allows examination of both upper and lower part of the abdominal cavity.
