Endoscopic surgery is a field of surgery which allows specially trained surgeons to perform operative or diagnostic procedures either through pin-holes of tissues (ie, laparoscopy), or through natural physiological openings (ie. hysteroscopy, namely visualisation of the uterine cavity via a camera inserted through the uterine cervix).
In gynaecology, in particular, the vast majority of procedures can be carried out endoscopically. Operations, such as laparoscopic removal of ovarian cysts, removal of fibroids, treatment of endometriosis, (sub)-total hysterectomy and hysteroscopic removal of endometrial polyps and fibroids are routinely performed all over the world.
There are a number of advantages to the patient when an operation is performed laparoscopically as opposed to an open procedure.
Among others, these include:
- Smaller incisions, which reduces post-operative pain, leading to less pain killers needed
- Reduction of the period of disablement by 4-5 times. Often, a same day discharge is feasible, which leads to a faster return to everyday activity.
- Faster recovery and mobilisation and reduced hospital stay, which in turn, reduce risks of thrombosis and risk of in-hospital infection.
- Much reduced risk of surgically-induced post-operative adhesions
- The risk of postoperative hernia developing is minimal. Such a risk is significant following “open” surgery, especially after a mid-line abdominal incision.
- Excellent cosmetic result. The traces of 5-10mm scars caused by the laparoscopic approach are incomparable with the scars following an “open” approach.
- Financial benefits. Although the cost of the endoscopic operation may be higher than the “open” approach, mostly due to the high cost of equipment being used, this mode of treatment may overall come to be more “economical” due to reduced expenses of hospital stay and reduced time of patients’ rehabilitation.
Limitations
- Laparoscopic procedure times are usually slightly longer compared to “open” procedures, although the opposite may be true in some cases.
- Special training of the surgeon is required to conduct these procedures. Not all surgeons can get used to the two-dimensional orientation (via the monitor) and certainly this extra training requires time. Experience in performing traditional operations is mandatory for surgeons performing laparoscopic operations, because conversion to an “open” operation can never be excluded and the patient needs to be aware of this. However, this very rarely happens.
- Laparoscopic operations have their specific complications, mostly associated with the risk of damaging anatomic structures due to the initial insertion of the portals, as well as the inconvenience of operating two-dimensionally. The use of carbon dioxide into the abdominal cavity, may very occasionally lead to the dysfunction of organs (cardiovascular, pulmonary, etc.). The introduction of recent techniques and advances (Robotic Surgery) has decreased some of these risks, but at a certain financial cost.
Overall, Laparoscopic and Hysteroscopic procedures are considered to be safe procedures, with reduced long-term adverse effects on patients, when compared with open procedures.
