Endoscopic Surgery

ENDOSCOPIC SURGERY

Endoscopy is the technique used by a physician to investigate the inside of a cavity or a hollow organ of the body or to perform surgery in those areas. Endoscopic surgery relies on the endoscope, a hollow tube with its own lighting and video system that allows the surgeon to see inside the body. Gynaecology endoscopic surgery is called a laparoscopy and the viewing of the endometrial cavity of the uterus is called a hysteroscopy. The laparoscope is inserted through a tiny incision in the abdomen below the umbilicus. Endoscopy of the Fallopian Tubes is also possible using a laparoscope. Laparoscopy as well as hysteroscopy are minimal invasive procedures that have many benefits but also limitations.

BENEFITS: - Quicker recovery than with open surgery

- Less pain

- Only one day hospitalization

- Less bleeding, bruising and swelling

- Less days off work.

LIMITATIONS: - Not all surgery can be done laparoscopically

- Complications like bowel and urethra injuries

are possible, also bleeding and infections

- The expense of the procedure is not necessarily less.

Longer operating time and costly instruments lead to

higher overall costs.

ENDOSCOPIC PROCEDURES THAT CAN BE PERFORMED:

1.) Diagnostic procedures: A. Laparoscopy

B. Hysteroscopy

C. Salpingoscopy

2.) Operative procedures A. Laparoscopic procedures

B. Hysteroscopic procedures

A. (i) Laparoscopic surgery for endometriosis

(ii) Laparoscopic ovarian surgery

(a) Removal of cysts / tumors

(b) Ovariolysis - cleaning of adhesions from the ovary

(iii) Laparoscopic tubal surgery

(a) Salpingolysis

(b) Salpingostomy

(d) Re-anastomosis of tubes

(iv) Laparoscopic uterine surgery

(a) Laparoscopic assisted vaginal hysterectomy

(b) Subtotal hysterectomy

(d) Laparoscopic uterosacral nerve ablation

(e) Ventrosuspension

(v) Other Laparoscope procedures

(a) Appendisectomy

(b) Vesicosuspension for stress incontinence of bladder.

B. (i) Hysteroscopic resection or ablation of the endometrium

(ii) Exction of fibroids or polyps

(iii) Lysis of endometrial adhesions

The following instruments are also used to perform these minimal invasive surgeries through a second and third incisions in the abdominal wall:

(i) Scissors, Forceps, bipolar forceps, cautery.

(ii) Argon beam coagulator

(iii) Harmonic scalpel (with vibrating blade)

(iv) Nd:Yag Laser

WHAT SHOULD YOU KNOW WHEN BOOKED FOR A LAPAROSCOPY OR HYSTEROSCOPY:

1.) Do not eat or drink for 8 hours prior to the procedure.

2.) Your doctor will tell you what time to report to the hospital on the day of the procedure.

3.) The anaethetist will see you in the ward before you are taken to theater.

4.) If you are on medication at the time consult with your doctor whether or not you should continue with it.

5.) After the procedure your physician will discuss the findings with you and after a examination discharge you from hospital. Medication for pain will be prescribed. This should be used every 4 hours. Lozenges will help for a painful throat.

However, if your doctor is not satisfied with your condition he will keep you in hospital overnight and re-evaluate the next day. The doctor will also tell you when to make your next appointment.

6.) Care at home: Expect to feel uncomfortable and sore for a few days after the procedure. Do not engage in strenuous activity until after your follow-up visit to the doctor. Painkillers give a false sense of wellness. Therefor even if you do feel well - take it easy for as long as your doctor recommends.

Residual carbon dioxide in the abdomen can present itself as a shoulder pain and a sharp pain under the diaphragm. This pain will disappear in a day or two. It will help to move around while this pain remains. It also helps to drink hot water or tea.

You should call your doctor when things go wrong or when you are not certain of what is happening to you.