Laparoscopy

What Is Laparoscopy? How Does It Work? Technical Details

Laparoscopy is the endoscopic examination of the abdominal cavity and the performance of surgical procedures within it. The procedure is generally performed under general anesthesia, and its basic principle is as follows:

1. Small Incision and Gas Insufflation: A small incision, usually 0.5 to 1 cm in size, is made at or just below the level of the navel. Through this incision, the abdominal cavity is entered using a special needle or an instrument called a trocar, and the abdominal cavity is inflated with carbon dioxide (CO2) gas (pneumoperitoneum) so that the internal organs can be seen more clearly and the surgical instruments can move freely.
2. Placement of the Camera (Laparoscope): After the abdomen is inflated, a thin, tube-shaped instrument called a laparoscope, with a high-resolution camera and a light source at its tip, is inserted through the same umbilical incision. The images transmitted by the laparoscope are projected, magnified, onto a video monitor in the operating room via fiber-optic cables.
3. Placement of Surgical Instruments: To use the thin, long specialized surgical instruments required to perform the operation (graspers, scissors, tissue dissectors, energy devices – cautery, ultrasonic dissectors, vessel-sealing devices, suturing instruments, suction devices, etc.), the surgeon makes additional small incisions, usually 1 to 3 (sometimes more), of 0.5 cm in size, in the lower abdomen and inserts the instruments into the abdomen through trocars placed in these incisions.
4. Performing the Operation: While directing the camera with one hand, the surgeon uses precise surgical instruments with the other hand or hands, watching the magnified image on the monitor, to perform the planned operation (cyst removal, myoma removal, hysterectomy, tubal ligation, etc.).
5. Completing the Procedure: After the operation is completed, the gas in the abdomen is released, the instruments and camera are removed, and the small incisions are usually closed with cosmetic sutures or special surgical tape.

In Which Situations Is Laparoscopy Used in Gynecology? (Wide Range of Applications)

Laparoscopy has a very wide range of applications in modern gynecology. It is a method frequently used for both diagnostic and therapeutic purposes:

Diagnostic Laparoscopy Applications:

• Unexplained Chronic Pelvic Pain: To investigate the source of long-standing groin or abdominal pain whose cause could not be identified by other methods (adhesions, endometriosis, etc.).
• Unexplained Infertility: To evaluate the condition of the fallopian tubes (patency, adhesions), the ovaries, and the outer surface of the uterus in order to investigate the cause of the inability to conceive. Sometimes, dye can be injected through the tubes during the procedure (chromopertubation) to check tubal patency as well.
• Suspected Endometriosis: It is the gold-standard method for making a definitive diagnosis of endometriosis and determining the extent (stage) of the disease.
• Suspected Ectopic Pregnancy: When the diagnosis cannot be confirmed by ultrasound and blood tests, or for treatment purposes.
• Evaluation of Pelvic Masses: To better understand the nature of masses such as ovarian cysts or myomas, or to assess their relationship with other organs.
• Suspected Pelvic Infection or Abscess: To assess the severity of the condition and perform drainage if necessary.

Operative (Therapeutic) Laparoscopy Applications:

• Ovarian Cyst Surgery: Removal of benign ovarian cysts (laparoscopic cystectomy) or complete removal of the ovary (laparoscopic oophorectomy).
• Myoma Surgery: Removal of myomas of appropriate size and number while preserving the uterus (laparoscopic myomectomy).
• Hysterectomy (Removal of the Uterus): Removal of the uterus, either completely or partially (leaving the cervix), using a minimally invasive technique (TLH, LAVH, LSH).
• Endometriosis Surgery: Cauterization or excision of endometriosis foci, removal of chocolate cysts (endometriomas), and release of adhesions caused by endometriosis (adhesiolysis).
• Surgeries Related to the Fallopian Tubes:
  
  • Ectopic pregnancy treatment (tube-preserving – salpingostomy, or tube removal – salpingectomy).
  • Tubal ligation (laparoscopic tubal ligation – a permanent birth control method).
  • Repair of blocked or damaged tubes (tuboplasty – success rate is limited).
  • Removal of the tube in cases of fluid accumulation (hydrosalpinx) (salpingectomy – usually performed before IVF).
• Release of Pelvic Adhesions (Adhesiolysis): Freeing adhesions that develop as a result of previous surgeries or infections and that cause pain or infertility.
• Pelvic Organ Prolapse Surgery: Suspension procedures performed to correct uterine or vaginal prolapse (laparoscopic sacrocolpopexy, sacrohysteropexy).
• Early-Stage Gynecological Cancer Surgery: Can be performed by experienced gynecologic oncologists for the treatment or staging of selected early-stage uterine, cervical, or ovarian cancers.

What Are the Advantages of Laparoscopy Over Traditional Open Surgery?

As a minimally invasive method, laparoscopy offers many advantages compared to open surgery (laparotomy):

• Better Cosmetic Results: Instead of a large surgical scar, only a few small, dot-like marks remain.
• Less Postoperative Pain: Because the incisions are small and there is less tissue trauma, patients experience less pain after surgery.
• Shorter Hospital Stay: Patients can usually be discharged within 1-2 days, and sometimes even on the same day.
• Faster Recovery and Return to Work: The time to return to normal daily activities and work is significantly shorter (usually 1-3 weeks).
• Less Blood Loss: The amount of bleeding during surgery is generally lower.
• Lower Risk of Infection: The risk of wound infection in particular is lower.
• Fewer Intra-Abdominal Adhesions: The likelihood of adhesions forming between organs after surgery is lower.
• Better Visualization: The laparoscopic camera magnifies and shows the surgical field in detail, allowing the surgeon to work with greater precision.

How Is a Laparoscopic Operation Performed? General Process

A laparoscopic gynecological operation generally follows the process outlined below:

1. Preoperative Preparation: The patient’s medical condition is evaluated, the necessary blood tests are performed, and the patient is examined by the anesthesiologist. The patient is asked to fast and avoid drinking after a certain time on the night before surgery. Bowel cleansing may be performed if necessary. Detailed information about the operation is given and consent is obtained.
2. The Operation: The patient is taken to the operating room and general anesthesia is administered. After the patient is positioned appropriately and sterilization is performed, the operation is started using the technique described above (gas insufflation, camera and instrument entry). The planned surgical procedure (cyst removal, myoma removal, hysterectomy, etc.) is performed. Bleeding is controlled, the abdominal cavity is irrigated, the gas is released, and the incisions are closed.
3. After the Operation: The patient is woken from anesthesia and taken to the recovery room. Here, vital signs (blood pressure, pulse, respiration) are monitored for a period of time. Pain control is provided. Once the patient’s condition is stable, she is taken to her room in the ward. Early mobilization – getting up and walking – is encouraged. Oral feeding is usually started shortly afterward.

What Are the Risks and Possible Complications of Laparoscopy?

Laparoscopy is a fairly safe method when performed by experienced surgeons. However, as with any surgical procedure, there are some risks and potential complications, although these are rare:

• Anesthesia-Related Risks: The general risks associated with general anesthesia.
• Bleeding: Unexpected bleeding may occur during or after the operation.
• Infection: Infection may develop at the incision sites or within the abdomen.
• Organ Injury: In rare cases, injury to the bladder, bowel, ureter, or major blood vessels may occur, particularly during trocar insertion or during the operation. This risk may be somewhat higher in patients who have previously undergone abdominal surgery and have adhesions.
• Shoulder Pain: A common postoperative symptom, caused by residual CO2 gas in the abdomen irritating the diaphragm. It is temporary and usually resolves on its own within a few days.
• Gas Embolism: A very rare but serious complication.
• Blood Clotting (DVT/PE): There is a risk of deep vein thrombosis or pulmonary embolism. This risk is reduced through early mobilization and, sometimes, blood thinners.
• Incisional Hernia: A hernia may rarely develop, particularly at 10 mm trocar entry sites.
• Possibility of Conversion to Open Surgery: If an unexpected situation is encountered during laparoscopy, such as technical difficulties, uncontrollable bleeding, adhesions, or organ injury, the procedure may be converted to open surgery for the patient’s safety.

Before the operation, your doctor will inform you of the risks specific to your case.

What Is the Recovery Process Like After Laparoscopy?

Recovery after laparoscopy is much faster and more comfortable than after open surgery:

• Hospital Stay: This varies depending on the extent of the operation but is generally 1-2 days. Same-day discharge is sometimes possible.
• Pain: Pain is generally mild and can be controlled with oral pain relievers.
• Activity: Patients can usually walk the next day. Return to normal daily activities and desk work generally occurs within 1-2 weeks. Waiting 3-6 weeks may be necessary before starting physically demanding work or strenuous exercise (depending on the operation performed).
• Wound Care: The small incisions are usually closed cosmetically and do not require special care. Showering is generally permitted after a few days.
• Follow-Up: Postoperative check-up examinations are performed on dates determined by your doctor. Pathology results (if applicable) are evaluated.

Laparoscopic Surgery in Ankara: Prof. Dr. Nuray Bozkurt’s Expertise and Minimally Invasive Approach

Prof. Dr. Nuray Bozkurt adopts modern, patient-friendly methods in the surgical treatment of gynecological conditions. Her approach to laparoscopy is as follows:

• Priority on Minimally Invasive Surgery: In cases suitable for the patient, she prefers the laparoscopic method over open surgery, aiming to offer her patients faster recovery, less pain, and better cosmetic results.
• Broad Scope of Application: She has extensive experience performing many gynecological operations laparoscopically, including ovarian cysts, myomas (in suitable cases), ectopic pregnancy, endometriosis, tubal ligation, and hysterectomy.
• Diagnostic Value: She effectively uses diagnostic laparoscopy in situations such as unexplained pelvic pain or infertility.
• Safety and Experience: She performs laparoscopic surgery in safe hospital settings in Ankara equipped with the necessary technological infrastructure, together with experienced anesthesia and operating room teams. She keeps patient safety at the highest level at every stage of the operation.
• Thorough Information: Before the operation, she comprehensively informs her patients about the details, advantages, possible risks, and recovery process of the laparoscopic procedure.
• Patient Follow-Up: She closely follows the postoperative recovery process and provides the necessary support. Being easily reachable is important (0538 983 18 78)(0312 284 00 12).

If you need to undergo a gynecological operation and are wondering whether the minimally invasive (laparoscopic) option is suitable for you, you can visit our clinic in Ankara to get Prof. Dr. Nuray Bozkurt’s expert opinion. To benefit from the advantages offered by modern surgery and regain your health in the most comfortable way, please call 0538 983 18 78 to make an appointment.