Minimally Access Surgery

Endoscopy means "looking inside" and refers to looking inside a body cavity using camera like device called an endoscope. With the advent of its development and use in human it became possible to perform surgeries inside the body with minimum scar and maximum postoperative comfort. In gynaecology it has been put to use in procedures involving uterus, tubes, ovary by laparoscopy for diagnosing and operating. Also a similar camera can be used to visualise the uterine cavity to detect and treat uterine anomalies known as hysteroscopy

LAPAROSCOPY

Laparoscopy is a technique in which operations in the abdomen are performed through small incisions as compared to larger incisions needed in open surgery. Laparoscopic surgery includes operations within the abdominal or pelvic cavities. Laparoscopy was initially used primarily for diagnosis in cases of chronic pelvic pain, pelvic masses, or for the suspicion of an ectopic pregnancy and for tubal ligation. Now as manv as 80 per cent of gynaecological operations can now be performed endoscopically.

ADVANTAGES:

• When compared to conventional open surgery it has the following advantages:
• Rapid postoperative recovery
• Less postoperative pain and reduced need of postoperative analgesia
• Although procedure times are usually slightly longer, hospital stay is less, and often with a same day discharge which quals a faster return to everyday living.
• Reduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections and postoperative adhesions.
• Less adhesion formation
• Reduced blood loss, which equals less risk of needing a blood transfusion.
• Smaller abdominal scars (cosmetic value).

INDICATIONS FOR LAPAROSCOPY

DIAGNOSTIC LAPAROSCOPY

• Evaluation in infertility
• Chronic pelvic pain
• Suspected endometriosis\
• Evaluation of mullerian anomaly
• Prior to tuboplasty
• Suspected ectopic pregnancy
• Acute pelvic inflammatory disease
• Torsion of adnexa

OPERATIVE LAPAROSCOPY

Most of the gynaecological surgeries can be performed laparoscopically: Cystectomy, salpingectomy, tubal ligation, oopherectomy, hystrectomy

HYSTEROSCOPY

Hysteroscopy is the inspection of the uterine cavity by endoscopy. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical inter­vention (operative hysteroscopy).

• Advantages Operative hysteroscopy has in many ways superceded laparoscopy in meeting the minimal invasive criteria. It uses the endocervical canal, the bodies natural passage, to gain entry into uterine cavity and has been used for septal and adhesion resection. Submucous fibroid (cavity fibroids) removal no longer requires a hysterotomv. Cornual and interstitial tubal obstruction can also be managed hvsteroscopicallv.

DIAGNOSTIC HYSTEROSCOPY IS INDICATED IN EVALUATION OF THE UTERINE CAVITY IN PATIENTS WITH:

• Infertility (to evaluate abnormal hvsterosalpingo-grams - filling defects, adhesions)
• Abnormal Uterine Bleeding (menorrhagia, irregular bleeding, postmenopausal bleeding)
• Mullerian abnormalities (in patients with recurrent pregnancy loss - septate uterus
• Lost or misplaced IUD's

INDICATIONS OF OPERATIVE HYSTEROSCOPY

• Targeted endometrial biopsy
• Removal of polyps, sub-mucous myoma
• Adhesiolysis
• Metroplasty (incision of uterine septum)
• Removal of misplaced IUD or foreign body
• Tubal cannulation in cornual or interstitial block
• Treatment of DUB (Endometrial ablation, TCRE)
• Sterilisation (electrocoagulation or tubal plugs to block the tubes)