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Endoscopic surgery is surgery done using a telescope and long instruments which may be inserted through tiny incisions.
Laparoscopic or minimum access or key-hole surgery is abdominal surgery which is done through multiple tiny incisions over the abdomen. A telescope connected to the camera is inserted usually at or near the umbilicus and the remaining incisions are used to insert various instruments to perform surgery.
Laparoscopic surgery has many advantages :
• Smaller incisions
• Better (magnified) surgical view for the operating surgeon
• Faster recovery
• Less postoperative pain
• Fewer postoperative adhesions and low risk for hernia formation
In gynaecology, almost all major surgeries are undertaken through the laparoscope. Hysterectomy (removal of uterus), myomectomy (fibroid excision), ovarian cystectomy, endometriosis surgery, PCOS drilling, diagnostic laparoscopy to detect the cause of infertility as well as tubal reconstructive surgery for damaged or blocked tubes are some of the surgeries which are routinely advocated laparoscopically. These days, even radical hysterectomy (for cancer uterus or cervix) and surgery for cancer ovaries may be performed laparoscopically by experienced surgeons.
There are different ways of removal of large tumors through small incisions. One of them is to core the specimen into long thin strips, using an instrument called morcellator and removing them through a 12 mm or 15 mm incision. Removal of the uterus after laparoscopic surgery is undertaken through the vagina. A very large uterus may be partly morcellated and the rest of the specimen removed vaginally.
In most set-ups, extreme care is taken to prepare the patient and OT before surgery as also adequate precautions are taken during surgery to avoid mishaps. In good hands, the procedure is as safe as open surgery.
As in any other major surgery, there is a risk of incurring complications from anaesthesia. Most of the laparoscopic surgeries are conducted under general anaesthesia. These are, fortunately, very rare, and include respiratory or cardiac complications.
Other than that, injury to internal organs such as intestines or blood vessels may rarely occur, especially while inserting the initial trocars and needles into the abdomen. Injury to the urinary tract may occur during gynaecological procedures.
Other rare events include injury to organs from use of electric current or depression of the heart or breathing from excess carbon dioxide gas entering into circulation.
Certain cases are better tackled by open surgery. For example, in case of an abdominal tumor which very large, the surgeon may opt for an open procedure, depending on his/her experience. The laparoscopic surgeon has to decide based on his team’s ability
as well as the size and location of the tumor whether to undertake laparoscopic surgery and if yes, how to remove it. In cases of cancerous tumors, care has to be taken to remove the tumor intact to avoid spillage of cancer
cells into the abdomen. Hence, many cancer surgeries are better done through open surgery. Yet, many can be tackled effectively, if not better through the laparoscopic route.
If your patient has undergone multiple previous surgeries or has suffered from abdominal tuberculosis, the intestines may be stuck to the anterior abdominal wall and hence, the risk of injury to internal organs is increased and your doctor may counsel you to prefer an open procedure. But these decisions are best taken by mutual counselling between the surgeon and patient and after understanding all aspects of the case.
Laparoscopic equipments are expensive and incur higher maintenance cost. The surgeon undergoes rigorous training for years before becoming an ‘expert’. During the operation, various gases are used (carbon dioxide, oxygen, nitrous oxide) and specialized monitors come into play. The procedure may last about one and a half time that of an open surgery. Thus, the cost of surgery is higher. However, this is often compensated by the reduced number of hospital stay and less post-operative pain medications and antibiotics.