Laparoscopy

Introduction

Laparoscopy and Hysteroscopy are the endoscopic techniques in Gynecology. Laparoscopy is a minimal invasive surgery (MIS), in which the operation is performed through small surgical holes (diameter of 5mm and 10mm) in the abdominal wall. Due to laparoscopy technique, the patients have shorter hospitalization, less postoperative pain, faster rehabilitation and better cosmetic outcome compare to laparotomy (open surgical procedure).
The laparoscopic surgery is performed after the creation of pneumo-peritoneum (gas CO2 in peritoneal cavity). By this, the surgeon has the internal visualization of the abdomen. Thereafter, using optical systems (optic tube, camera, monitors) and laparoscopic tools of high quality the surgical team organizes the surgical treatment upon the patient’s disease (Figure 1,2).

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Figure 1. Laparoscopic surgical set
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Figure 2. Laparoscopic tools of high quality

Indications

Via laparoscopy can be done, almost the total of the Gynecologic operation. Surgical skills and the relevant equipment for the minimal invasive surgery are obligatory. However, the most often indications for laparoscopic surgery in Gynecology are:
• Extra-uterine pregnancy
• Pelvic abscess (fallopian tubes, ovary)
• Adnexal torsion
• Endometriosis
• Ovarian masses (solid, cystic)
• Leiomyomas
• Oncologic diseases of genital tract
Using the laparoscopic technique can be done: cystectomy, adnexectomy (extraction of fallopian tube & ovary), myomectomy, total or subtotal hysterectomy, lymphadenectomy, omentectomy, etc, upon the indication of the gynecologic disease (Figure 3,4).

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Figure 3. Dissection of the fallopian (right) tube, during laparoscopic hysterectomy with reservation of both tubes and ovaries
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Figure 4. Closure of the vaginal vault, after laparoscopic (total) hysterectomy

Complications

The rate of laparoscopic complications is as high as 7-9%. However the rate of severe complications is between 1-2%. The half of the complications is performed during the creation of the pneumo-peritoneum and the most common are:
• Intestinal injury
• Perforation of urine bladder
• Injury of vessels
Iliac artery or vein
Abdominal aorta
Vena cava
• Hematoma of the abdominal wall (trocars’ holes)
• Postoperative hernia (especially of 10mm trocars)
The rate of laparo-conversion (conversion of laparoscopy to laparotomy) is almost 5%. The reasons of the laparo-conversion are mainly the obesity, cardio-pulmonary failure, elderly patients, metastatic disease, adhesions from previous abdominal operations, un-control heavy bleeding during the laparoscopic procedure.

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Kalogiannidis doctor

IOANNIS Α. KALOGIANNIDIS MD, PhD

Associate Professor
Obstetrics Gynecology -
Gynecologic Oncology

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