Laparoscopic hysterectomy
Surgical removal of the uterus (womb) is known as hysterectomy. It is a major gynaecological surgery. When it is done by laparoscopic method, it is called laparoscopic hysterectomy. Hysterectomy is required to remove uterus (womb) when it is having a diseased condition like fibroids (non-cancerous growths that develop in or around the womb), Adenomyosis (thickening of the uterine wall) and also due to uncontrolled abnormal uterine bleeding. Laparoscopic approach for hysterectomy carries many advantages over open approach such as less pain, less discomfort, less risk of infection and cosmetically better scars and fast recovery and return to normal activity.
Laparoscopic myomectomy
Laparoscopic myomectomy is the removal of fibroid/s by laparoscopy while preserving the uterus (womb). It is surgery for women who wish to have children in the future. The laparoscopic approach for the removal of fibroids depends on the size, number, and position of the fibroids and also the availability of appropriate laparoscopy facilities and skilled persons to perform laparoscopic myomectomy. Though laparoscopic myomectomy is not suitable for every fibroid patient, in selected patients it gives the best results.
Laparoscopic surgery for prolapse
Laparoscopic surgery for pelvic organ prolapse is also an option instead of vaginal surgeries in pelvic organ prolapse. Prolapsed pelvic organs can be replaced to their normal position by laparoscopic surgery by suspension procedures and sometimes with the help of a mesh. It will lead to relieving symptoms such as pressure symptoms, urinary symptoms, bowel dysfunction, pain, and discomfort. The laparoscopic sacrohysteropexy (surgical procedure to correct uterine prolapse) is one example of laparoscopic surgery done for pelvic organ prolapse. In only few centers in Sri Lanka this surgery is performed.
Laparoscopic sterilization
Laparoscopic sterilization is the surgery for birth control for women. It is a permanent method of contraception. In this process, fallopian tubes are cut or blocked and then prevent pregnancy by blocking the pathway of the ovum (egg) to the sperm and uterus (womb). The laparoscopic approach is the best method to do this surgery with minimal complications.
Laparoscopic oophorectomy
Laparoscopic oophorectomy is the surgical procedure to remove one or both ovaries. Developing an ovarian cyst or a mass and also accidents to the ovarian cyst such as hemorrhage and bleeding into the cyst are the most common indications of oophorectomy.
Pain, pressure on the bowels or bladder, bloating, and tiredness are common symptoms of an ovarian cyst. Removed ovaries can be checked histologically and see whether it is a cancer or not. When a woman has a positive family history of ovarian cancer, this surgery can be performed even before the disease onset.
Laparoscopic salpingo-oophorectomy
The removal of the ovaries and fallopian tubes is collectively known as salpingo – oophorectomy. Removal of one ovary and fallopian tube known as unilateral salpingo-oophorectomy and when both are removed, it’s called a bilateral salpingo-oophorectomy. Any diseased condition of ovary and tube are the reasons for this surgery.
A special surgical entity known as risk-reducing salpingo-oophorectomy is done for women who are having a particularly high risk for ovarian cancer in which healthy ovaries and fallopian tubes are removed.
Laparoscopic salpingectomy
Laparoscopic salpingectomy is the removal of a fallopian tube when there is a tubal disease. The commonest tubal condition which needs salpingectomy is the tubal ectopic pregnancy (fertilized egg implants itself outside of the womb, usually in one of the fallopian tubes). Laparoscopic approach is the best way to perform salpingectomy as it is minimally invasive and the recommended method for this surgery.
Laparoscopic adhesiolysis
Adhesions are bands of scar tissue that develop after surgery in the abdomen or pelvic area. Adhesiolysis is the surgical removal of these scar tissues. Adhesions (Scar tissues) can lead to symptoms like chronic abdominal pain, pelvic pain, and bowel obstruction. Laparoscopic adhesiolysis is the surgery to divide adhesions to relieve these symptoms laparoscopically.
Laparoscopy and dye test
Laparoscopy and dye test is a diagnostic and therapeutic procedure, which can be used in
Sub fertile (delay in conceiving) women to detect tubal patency. A dye called “methylene blue” is injected to assess the patency of fallopian tubes. During this procedure if any tubal blocks, those can be cleared and patency can be reestablished. This is a safe and effective procedure without radiological exposure. The additional advantage of this procedure is we can clear any peritubal adhesions (scar tissues around the fallopian tubes) and also diagnose any other pelvic pathology and correct them.
Laparoscopic Burch colpo-suspension
Stress incontinence is involuntary leak of urine with increased intra-abdominal pressure in occasions like sneezing and coughing. It is a one of the most embarrassing condition and women may limit their day today activities and it reduces their quality of life.
This surgery is performed to cure this condition and it gives excellent results to overcome this problem.
Diagnostic Laparoscopy
Laparoscopy is used to diagnose diseases as well. When we investigate a patient for their symptoms, sometimes all blood and urine investigations are normal. Also their radiological investigations can be normal or not conclusive. In such instances laparoscopy is used to diagnose intra-abdominal conditions by visualizing abdominal cavity under direct vision. The advantage of it is if there is a diseased condition most probably it can be treated or at least can plan what we can do.
Laparoscopic surgery in Pelvic Inflammatory Disease (PID)
In severe form of PID where there is pelvic abscess or pelvic collection of pus or inflammatory exudates, surgical intervention is needed to drain or remove those collections. Laparoscopic surgery can be used safely with minimal intervention to perform appropriate surgery by an experienced laparoscopic surgeon when required laparoscopy facilities are available.
Diagnostic hysteroscopy
Hysteroscopy is the visualization of inside the uterine cavity (womb) using a camera system similar to laparoscopy. The distension media is saline or glycine instead of carbon-dioxide in laparoscopy. This surgery is performed when we need to assess uterine cavity for various reasons such as in subfertility or when ultrasound scan shows polyp or fibroid within the cavity and also as an investigation for endometrial carcinoma.
In severe form of PID where there is pelvic abscess or pelvic collection of pus or inflammatory exudates, surgical intervention is needed to drain or remove those collections. Laparoscopic surgery can be used safely with minimal intervention to perform appropriate surgery by an experienced laparoscopic surgeon when required laparoscopy facilities are available.
Hystero Laparoscopy
Some special occasions, laparoscopy is combined with hysterectomy and evaluates endometrial cavity and pelvic cavity at the same surgery. The commonest reason we perform Hystero-laparoscopy is in the investigations of subfertility to evaluate female reproductive system.
