LAPAROSCOPY IN
GYNAECOLOGY
For Medical Students
BY
PROF. Yamuna Aminu Kani
MBBS,FWACS, F.MAS, D.MAS, F.ART
SYNOPSIS
• INTRODUCTION
• HISTORY
• ADVANTAGES AND DISADVANTAGES
• INSTRUMENTS
• APPLICATION (DIAGNOSTIC AND THERAPEUTIC)
• CONTRAINDICATIONS
• RISK FACTORS
• COMPLICATIONS
• SAFETY MEANS
• CONCLUSION
INTRODUCTION
• The term ‘laparoscopy’ originates from the Greek terms
Lapara- soft part of the body between rib margins and hips
Skopein- to see or view or examine
“Laparoscopy is a marriage of modern technology and surgical
innovations that aims to accomplish surgical therapeutic and
diagnostic goals with minimal somatic and psychological trauma”
“Laparoscopic surgery also called minimally invasive surgery, bandaid
surgery or keyhole surgeryis a modern surgical technique in which
abdominal and pelvic operations are performed far from their
locations through small holes with the help of pneumoperitoneum”
HISTORY
• 1902: George Kelling of Dresden performed the first laparoscopic
procedure on dogs
• 1910: Hans Christian Jacobaeus of Sweden performed the first
laparoscopic operation on humans
• 1980: Patrick Steptoe performed laparoscopic procedures in the operating
room under sterile conditions
• 1982: The first solid state camera was introduced and this was the start of
video laparoscopy
• 1983: First laparoscopic appendectomy by Semm a German gynaecologist
• 1985: First laparoscopic cholecystectomy by Erich Muhe a German
surgeon
• 1987: First laparoscopic repair of inguinal hernia by Ger
• 1989: First laparoscopic hysterectomy Reich et al.
ADVANTAGES
• Shortens hospital stay
• Less pain and post-op discomfort
• Smaller scars
• Lesser soft tissue handling
• Early ambulation
• Reduced risks of acquired infection
DISADVANTAGES
• Requires long learning curve
• Limited range of motion
• Expensive instruments
INSTRUMENTS
• Verres needle
Used to introduce gas to the peritoneal cavity (pneumothorax) through
the umbilicus.
• Insufflator
Used to insufflate through the verres needle
Maintains constant intraabdominal pressure without exceeding safety
limit (10-13mmhg)
CO2 is used because it has the same refractive index as air, doesn’t
distort image and its non combustible
INSTRUMENTS
• Trocars
Used to make small puncture like incision through the skin which
permits other surgical instruments to be introduced.
• Telescope
Used to visualize the peritoneal cavity
INSTRUMENTS
• Camera unit and light source
The camera unit consists of the camera head, camera control and a TV
monitor.
The image seen through the telescope is processed through the camera
control facility and which is connected to a TV monitor.
A high intensity light source like halogen or xenon or LED is introduced
through the laparoscope with a fibreoptic cable powered from a light
source.
• Forceps and scissors
Can be atraumatic or grasping
Disposable or reusable
APPLICATION
DIAGNOSTIC
• Infertiliy
• Ovarian cysts or tumors
• Ectopic pregnancy
• Pelvic inflammatory disease
• Endometriosis
• Chronic pelvic pain
• Uterine fibroids
• Oncologic procedures
APPLICATION
THERAPEUTIC
• Ovarian cyst • Myomectomy
Drainage For subserosal and intramural
Ovarian cystectomy fibroid
Correcting ovarian torsion
• Pelvic inflammatory disease
• Infertility Draining of tubal abscess
Adhesiolysis Adhesiolysis
Ovarian wedge resection
Ovarian drilling
CONTRAINDICATIONS
• Generalized peritonitis
• Hypovolaemic shock
• Severe cardiac disease
• Hb < 7g/dl
• Uterine size >12 weeks
• Previous multiple abdominal procedures
• Extreme body weight BMI ≥ 40
RISK FACTORS
• Patient related
1.Obesity
2.Age
3.Previous abdominal surgery
• Anaesthesia related
1.Time since last oral intake
2.Heart disease
3.Pulmonary disease
COMPLICATIONS
• Hollow visceral injury
• Solid organ injury
• Vessel injury
• Ureteral injury
• Gas embolism
• Leak
• Capasitive coupling
SAFETY MEANS
• Proper training programs
• Proper patient monitoring throughout procedure
• Proper sterilization of equipments
• Achievement of best possible picture, field and vision
• Avoidance of any blind step
• Conversion into an open surgery is not a failure
CONCLUSION
• Laparoscopy is now the gold standard for operative treatment of
many abdominal and pelvic surgeries.
• Laparoscopy provides first hand visual comprehension of the problem
as well as an immediate opportunity to continue with therapeutic
surgical correction.
• In the past, many of these procedures would have been limited to
laparotomy and would have required a prolonged recovery period
