Laparoskopi | Bulenturman

LAPAROSCOPY

Laparoscopic Surgery

Endoscopic procedures in women are divided into two main categories: laparoscopy and hysteroscopy. Laparoscopy is a procedure in which the abdominal cavity is examined using an endoscope. While laparoscopy was initially used only as a diagnostic tool, today nearly all gynecologic surgical procedures can be performed using laparoscopic techniques.

Who Is Suitable for Laparoscopic Surgery?

Endoscopic surgery may be performed in most patients whose general medical condition is suitable for surgery. However, in patients with severe cardiac or respiratory disease, laparoscopy may not be preferred, as the procedure requires a head-down (Trendelenburg) position, which may not be well tolerated.

In women with very large or multiple fibroids, as well as in those with ovarian cancer, open surgery is generally preferred.

A significant proportion of endometrial cancers can be treated laparoscopically. Depending on the clinical situation, the procedure may be limited to removal of the uterus, or it may be extended to include sentinel lymph node sampling or complete pelvic lymph node dissection.

In cervical cancer, based on the results of randomized studies comparing open and laparoscopic surgery, open surgery is often preferred. However, this remains a subject of ongoing discussion, and the advantages and disadvantages of each approach should be carefully discussed with the patient before deciding on the surgical method.

Advantages of Laparoscopic Surgery

With advances in laparoscopic techniques, most surgeries that were traditionally performed through open abdominal incisions can now be carried out laparoscopically. The main advantages of endoscopic surgery result from the fact that the skin incisions are much smaller. The extent of the procedure performed inside the abdomen is comparable to that of open surgery.

As a result, patients generally experience less postoperative pain, require a shorter hospital stay, and are able to return to work and daily activities sooner.

Benefits of Laparoscopy

Shorter hospital stay
Faster recovery time
Earlier return to social and daily activities
Less intraoperative blood loss
Lower risk of postoperative anemia
Smaller skin incisions
Reduced risk of abdominal wall infections

In addition, some studies have reported a lower likelihood of intra-abdominal adhesion formation following laparoscopic surgery compared with open procedures.

Diagnostic Laparoscopy

Diagnostic laparoscopy is a surgical visual examination performed to investigate the cause of certain symptoms, particularly when there is no clear underlying diagnosis or associated clinical finding. However, the routine use of diagnostic laparoscopy has decreased in recent years.

When the medical history and physical examination are normal, and there are no risk factors such as prior pelvic surgery, pelvic infection, severe menstrual pain, or pain during intercourse—and when ultrasound and hysterosalpingography (HSG) findings are normal—the additional diagnostic value of laparoscopy is considered limited.

In such cases, laparoscopy may occasionally reveal:

Endometriosis
Mild pelvic adhesions
Rarely, false tubal occlusion due to temporary tubal spasm

Operative (Therapeutic) Laparoscopy

Operative laparoscopy refers to interventional procedures performed to treat a condition that has already been diagnosed. The goal is to remove pathological tissue or correct the underlying problem.

Examples include:

Excision of endometriosis lesions
Removal of ovarian cysts
Myomectomy (removal of uterine fibroids)
Surgical treatment of ectopic pregnancy
Opening or removal of the fallopian tubes

These procedures are therapeutic rather than diagnostic and are performed with the primary aim of treatment.

Complications of Laparoscopic Surgery

Approximately 70% of complications associated with laparoscopic surgery occur during entry into the abdominal cavity. These complications tend to be more serious and, in some cases, life-threatening. Examples include major vascular injuries and bowel injuries.

Complications that may occur during the surgical procedure itself include the following:

Incomplete Removal of Disease

This may occur when pathological tissue cannot be fully excised, most commonly in cases involving:

Fibroids that are difficult to access due to their size or location
Ovarian cysts that cannot be completely removed
Residual disease in patients with endometriosis, where affected tissue may remain behind

Bowel Injuries

If bowel injury occurs, repair may be required by converting to open surgery or performing additional surgical intervention. Delayed diagnosis of bowel injuries can be particularly serious and may be life-threatening.

Ureteral Injuries

The ureters are thin tubular structures that carry urine from the kidneys to the bladder. Due to their anatomical proximity, they may be at risk of injury during gynecologic surgery.

In conditions such as endometriosis, the ureters may rarely be involved along their full thickness, potentially impairing kidney function. In such cases, resection and subsequent repair of the ureter may be necessary.