Many abdominal disorders can be treated safely through the laparoscope at the same time that the diagnosis is made. When performing operative laparoscopy, the physician inserts additional instruments such as probes, scissors, grasping instruments, biopsy forceps, electrosurgical or laser instruments, and suture materials through two or three additional incisions. The choice of technique and instrumentation depends on many factors including the physician’s experience, location of the problem, and availability of equipment.
Some reproductive problems that can be corrected with operative laparoscopy include removing adhesions from around the fallopian tubes and ovaries, opening blocked tubes, removing ovarian cysts, and treating ectopic pregnancy. Endometriosis can also be removed or ablated from the outside of the uterus, ovaries, or peritoneum. Under certain circumstances, fibroids on the uterus can also be removed. Laparoscopic surgery can also be used to remove diseased ovaries and can assist in the performance of hysterectomy.
During the last 35 years, gynecologic laparoscopy has evolved from a limited procedure mainly used for diagnosis and tubal ligations to a major surgical tool used to treat a multitude of gynecologic indications. Today, laparoscopy is a commonplace surgical procedure.
For many procedures, such as removal of an ectopic pregnancy, treatment of endometriosis, or removal of ovarian cysts, laparoscopy has become the treatment of choice. Compared with laparotomy, multiple studies have shown laparoscopy to be safer, less expensive, and to have a shorter recovery time.
Many gynecologic operations are still performed via laparotomy. These tend to be cases where the damage inside the abdomen is more extensive and the surgeon needs more space to work. In a laparotomy, an incision (either “bikini line” or “up and down”) several inches long opens the abdomen. Patients generally remain in the hospital for several days following laparotomy and may return to work in two to six weeks, depending on the level of physical activity required. Surgery via laparotomy is much more debilitating than laparoscopic surgery.
Some types of surgeries may be too risky to perform with laparoscopy, while in others it is not clear that laparoscopy yields results as good as those by laparotomy. The surgeon’s experience also plays a role in deciding whether operative laparoscopy or laparotomy should be used. When considering a gynecologic operation, the patient and her doctor should discuss the pros and cons of performing a laparotomy versus an operative laparoscopy.
There are risks associated with laparoscopy. Postoperative bladder infection and skin irritation are most common. Adhesions may form. Hematomas of the abdominal wall can occur near the incisions. Pelvic or abdominal infections may also occur. However, serious complications of diagnostic and operative laparoscopy are rare. The major (though very rare) risk is damage to the bowel, bladder, ureters, uterus, major blood vessels, or other organs, which may require additional surgery. Injuries can occur during the insertion of various instruments through the abdominal wall or during operative treatment. Certain conditions may increase the risk of serious complications. These include previous abdominal surgery, especially bowel surgery, and a history or presence of bowel/pelvic adhesions, severe endometriosis, pelvic infections, obesity, or excessive thinness.
Allergic reactions, nerve damage, and anesthesia complications rarely occur. The risk of death as a result of laparoscopy is very small (around three in 100,000). When all possible complications are considered, one or two women out of every 100 may develop a complication, usually of minor consequence.
In addition to the general risks of surgery and the risks of anesthesia, a laparotomy poses its own risks. The risks vary based upon the underlying problem or disease that makes the procedure necessary, but the risks specific to the procedure are infection, incisional hernia, and bleeding from the surgery site.