Laparoscopic Surgery in Gynecology

Laparoscopic surgery is a minimally invasive technique widely used in gynecology for the diagnosis and treatment of various reproductive system disorders. It involves making small incisions and using a laparoscope (a thin tube with a camera and light) to visualize and operate on pelvic organs. Below are summaries of key laparoscopic procedures: Lap Myomectomy, Lap Cystectomy, Lap Ovarian Drilling, and Lap Tubal Reconstruction.

Lap Myomectomy

Definition:
Laparoscopic myomectomy is a minimally invasive surgical procedure to remove uterine fibroids (leiomyomas) while preserving the uterus. It is preferred for women who wish to retain fertility or avoid hysterectomy.

Indications:
• Symptomatic fibroids causing heavy menstrual bleeding (menorrhagia), pelvic pain, or pressure.
• Infertility related to fibroids, especially when myomas distort the uterine cavity.
• Rapidly growing fibroids or suspicion of malignancy.
• Palpable or enlarging fibroids, or those causing urinary symptoms or ureteral obstruction.

Benefits of Laparoscopic Approach:
• Smaller incisions, less blood loss, and reduced pain compared to open surgery.
• Shorter hospital stay and quicker recovery (usually 2–3 weeks).
• Lower risk of adhesions and postoperative complications.
• Suitable for multiple or moderately large fibroids (up to 8–10 cm, usually up to 4 fibroids).

Risks and Considerations:
• Risk of uterine rupture in future pregnancies (multilayer suturing is recommended to minimize this risk).
• Possible complications: bleeding, infection, injury to surrounding organs, adhesions.
• Most women will require cesarean delivery in future pregnancies due to uterine incision.

Lap Cystectomy

Definition:
Laparoscopic cystectomy is the surgical removal of ovarian cysts using minimally invasive techniques. The procedure aims to excise the cyst while preserving healthy ovarian tissue.

Indications:
• Symptomatic ovarian cysts (pain, pressure, or bloating).
• Cysts that are large, persistent, or suspicious for malignancy.
• Endometriomas, dermoid cysts, or functional cysts not resolving with observation.

Benefits:
• Minimally invasive, less postoperative pain, and faster recovery.
• Preservation of ovarian function and fertility.
• Reduced risk of adhesions compared to open surgery.

Lap Ovarian Drilling

Definition:
Laparoscopic ovarian drilling is a fertility-enhancing procedure for women with polycystic ovary syndrome (PCOS) who are resistant to ovulation-inducing medications.

Indications:
• Anovulatory infertility due to PCOS not responding to first-line treatments (like clomiphene or letrozole).
• Women seeking to induce ovulation and improve chances of conception.

Procedure:
• Small holes are made in the ovarian surface using electrocautery or laser to reduce androgen-producing tissue and restore normal ovulation.

Benefits:
• Can restore ovulation in 50–80% of women with PCOS.
• Minimally invasive, with a short recovery time.
• May reduce the need for higher doses of ovulation drugs.

Lap Tubal Reconstruction

Definition:
Laparoscopic tubal reconstruction involves surgical repair of damaged or blocked fallopian tubes to restore fertility.

Indications:
• Tubal blockages due to previous sterilization, infection, or endometriosis.
• Women desiring reversal of tubal sterilization.

Techniques:
• Tubal reanastomosis (rejoining tubal segments).
• Fimbrioplasty (repairing the fimbrial end of the tube).
• Salpingostomy (creating a new tubal opening).

Benefits:
• Minimally invasive alternative to open surgery.
• Faster recovery and less postoperative pain.
• Potential to restore natural fertility in selected cases.