Amit Patel

What is laparoscopy?
Laparoscopy (also known as keyhole or minimally invasive) surgery allows a surgeon to perform operation inside the abdomen (tummy) and pelvis without having to make large incisions on the skin.

How is it performed?
Once patient is asleep with general anaesthetic antiseptic preparations are made. A small needle is then passed through umbilicus (belly button) and carbon dioxide gas is pumped to inflate the abdomen (tummy). Inflation of abdomen reduces the risk of injury and allows the surgeon a better visual field and space to perform procedures. slightly larger (5-10mm) trocars (tubes) are then inserted through small holes in abdominal wall, one of which is used to for the laparoscope and others for the laparoscopic instrument that performs the planned procedure. Laparoscope is attached with the light sources and relays the pictures to a television screen. Several highly specialised laparoscopic instruments are available to carry out specific jobs during the operation.

After the planned procedure is completed, surgeon will ensure that there is no bleeding and will let out the carbon dioxide. All small incisions are closed using dissolvable stitches. Patient is then awaken.

How long does it take?
Depending on the indication it could take 30min (simple diagnostic laparoscopy) to upto 5 hours for complex cancer operation (e.g. trachelectomy)

What are the advantages?

• Shorter hospital stay and recovery time
• Less pain, bleeding and infection risk
• Cosmetically much less scarring

What are the disadvantages?
There are no real disadvantages of laparoscopic surgery compared to open surgery however…

• Not all gynaecological operations can be done laparoscopically. For example large tumours involving ovaries or uterus usually requires incision.
• Also laparoscopic surgery requires a complex set of skills which are acquired by specific training, special interest and continued exposure of complex laparoscopic procedures. Compared to open surgery laparoscopic surgery requires additional skills to accommodate 3D orientation, understanding of tactile sensation through instrument, ergonomics of laparoscopy and energy used through instrument and above all additional safety precautions specific to laparoscopic procedures.

What are the risks and complications?
Laparoscopy in gynaecology is a commonly performed procedure and serious complications are rare.
Minor complications include:

• Wound infection
• Minor bleeding or bruising around the incision
• Feeling or being sick

Serious complications include:

• Damage to an internal organ nearby such as bowel, bladder or ureters (urine tubes) during the operation
• Clots in leg or lung
• Heavy bleeding during operation

Which gynaecological procedures are performed with laparoscopy?

• Ovarian operations such as ovarian cyst/tumour removal, treatment of PCOS, oophorectomy for tumour or cancer risk reduction
• Fallopian tube procedures such as clip ligation (permanent contraception), removal of tube (ectopic pregnancy and cancer risk reduction)
• Uterine operations such as myomectomy (removal of fibroid) and hysterectomy
• Complex cancer operations such as radical hysterectomy, trachelectomy and lymph node excision
• Investigations and treatment of infertility, endometriosis and pelvic pain

What is hysteroscopy?
Hysteroscopy procedure allows visualisation of cervical canal and uterine cavity. It is mainly performed to diagnose cause of irregular periods or vaginal bleeding after menopause. It can also be used to take biopsies, treat polyps or fibroids.

How is it performed?
Simple diagnostic hysteroscopy or minor hysteroscopic procedures can be performed without general anaesthetic in a clinic. Whilst complex cases may require general anaesthetic. Eitherway patient do not need to stay in hospital. After antiseptic preparations vaginal speculum is inserted. Hysteroscope is then passed through the cervix and under image guidance inside uterine cavity. Water or special fluid is irrigated through hysteroscope to dilate uterine cavity and light attached to hysteroscope illuminates uterine cavity. Camera attached to hysteroscope relays images to television screen. Biopsy or removal of polyp or fibroid is then carried out as required.

After the planned procedure is completed, surgeon will ensure that there is no bleeding and will let out the excess fluid.

How long does it take?
Usually it takes about 10 - 30min depending on the aim of procedure.

What are the risks and complications?
Hysteroscopy in gynaecology is a commonly performed procedure and serious complications are very rare.
Minor complications include:

• Infection and vaginal discharge
• Minor bleeding afterwards

Serious complications include:

• Damage to the uterus or internal organs

Which gynaecological procedures are performed with hysteroscopy?

• Biopsy from cervical canal or endometrium (lining of uterine cavity) to rule out cancer
• Removal of polyp or fibroid polyp from cervical canal or uterine cavity
• Ablation of endometrium (treatment of heavy periods)
• Removal of lost coils

What is colposcopy?
A colposcopy is an examination to find out if there are precancerous or cancerous changes in cervix or vagina. Colposcopy is performed if women have abnormal bleeding, abnormality on cervical smear or if there are abnormal changes seen during examination by a GP.

How is it performed?
Colposcopy and colposcopic procedures are usually carried out in clinic and do not require general anaesthetic. After antiseptic preparations vaginal speculum is inserted and cervix is exposed. Colposcope is then used to magnify cervix. Light attached to colposcope illuminates cervix and vaginal surface. Camera attached to colposcope can relays images to television screen. Acetic acid and/or Lugol’s iodine solution is then used help identify abnormal areas in the cervix.

Small diagnostic (punch) biopsy, Loop (LLETZ) biopsy or removal of polyp is then carried out depending on the findings of the colposcopic examination. Local anaesthetic injection is used for loop biopsy and occasionally for the removal of polyp.

How long does it take?
Colposcopy usually takes about 10mins but if loop biopsy is required it can take additional 10mins.

What are the risks and complications?
Colposcopy is a very commonly performed procedure and complications are very rare.
Minor complications include:

• Infection and vaginal discharge
• Minor bleeding

Serious complications are rare include:

• Heavy bleeding during or after loop biopsy

Which gynaecological procedures are performed with colposcopy?

• Cervical cancer screening smear test
• Small punch biopsy from vaginal or cervical surface
• Large loop (LLETZ) biopsy to remove abnormal precancerous area from cervix
• Removal of cervical polyp
• Ablation of vaginal precancerous changes (requires general anaesthetic)

What is vulvoscopy?
A vulvoscopy is an examination of vulval skin performed using colposcope to investigate vulval diseases and problems including precancer and cancer of vulva. Vulvoscopy is performed if women have vulval soreness, itching, bleeding or abnormal lump.

How is it performed?
Vulvoscopy is usually carried out in clinic and do not require general anaesthetic. After antiseptic preparations colposcope is used to to magnify vulval skin. Light attached to colposcope illuminates vulval skin and camera attached to colposcope can relays images to television screen. Acetic acid and/or Lugol’s iodine solution may be used to identify abnormal areas in vulval skin.

Small diagnostic (punch) biopsy may be carried out depending on the findings of the vulvoscopic examination. Local anaesthetic injection is used prior to taking biopsy.

How long does it take?
Vulvoscopy usually takes about 5mins but if vulval biopsy is required it can take additional 10mins.

What are the risks and complications?
Vulvoscopy is a very simple examination and do not have any major risk. If biopsy is taken, rarely, women may experience minor bleeding or infection

Which gynaecological procedures are performed with vulvoscopy?

• small punch biopsy of vulval skin