LAPAROSCOPIC SURGERY – Op. Dr. Ufuk Yılmaz

LAPAROSCOPIC SURGERY

laparoskopik cerrahi nedirLaparoscopic Surgery is a diagnostic, evaluative, and surgical intervention method… Advances in imaging and instrumentation have led to an increase in surgical experience. As a result, laparoscopy, which was initially used only for diagnostic purposes and a few simple surgical procedures such as tubal ligation, has now become an alternative method for all surgical interventions that can be performed openly, and in some fields, it is even preferred. Laparoscopy offers advantages such as less postoperative pain, smaller surgical scars, lower costs, lower rates of bleeding, and shorter hospital stays compared to laparotomy. However, factors such as the requirement for surgical equipment, experienced personnel, previous abdominal surgery, and obesity can limit laparoscopic surgery.

Diagnostic Laparoscopic Surgery:

Diagnostic laparoscopy is performed for the examination of the patency of the fallopian tubes, general appearance of the ovaries, presence of adhesions, tubal-ovarian relationship, and overall appearance of the uterus.

Commonly known as “keyhole surgery” among the public, this method involves the insertion of a special optical device and camera system, which can enlarge the abdominal and pelvic areas several times larger than normal, through a 1 cm incision around the navel while the patient is under general anesthesia and the visualization of these areas by the special optical device and camera system.

During the procedure, the abdomen is adequately inflated with CO2 gas through the navel. Then, a tube called a “trocar,” with a diameter of 10 mm, is inserted into the abdomen through the navel. An optical instrument, called a “laparoscope,” connected to a camera-monitor system, is inserted into the abdomen through this tube. In this way, all the organs in the abdominal cavity are visualized.

Through this method, it is possible to determine whether the fallopian tubes are open or closed by injecting a blue-colored liquid called “methylene blue” through the cervix.

After diagnostic laparoscopy, the hospital stay is usually very short, and half a day is generally sufficient (the procedure can be performed in the morning, and the patient can be discharged in the evening).

The following findings are generally examined during diagnostic laparoscopy:

Patency of the fallopian tubes
General appearance of the ovaries
Presence of adhesions
Tubal-ovarian relationship
Overall appearance of the uterus
Operative Laparoscopy:
Many problems identified during diagnostic laparoscopy can be safely treated immediately through laparoscopic surgery. Laparoscopy performed for surgical correction purposes is called “operative laparoscopy.”

When performing laparoscopic surgery, a few additional incisions are made, and auxiliary tools such as scissors, electrocautery, laser, and sutures are introduced into the abdomen through a new trocar with a diameter of 5 mm. With these specially designed instruments, many surgical interventions can be performed inside the abdomen.

The selection of the appropriate tools and techniques depends on the doctor’s training, the location of the problem, and the adequacy of the equipment.

What Can Be Done in Operative Laparoscopy?

  • Removal of abdominal adhesions (adhesiolysis)
  • Removal of fibroids (myomectomy)
  • Removal or aspiration of ovarian cysts
  • Coagulation (burning) of endometriotic lesions in endometriosis treatment
  • Removal or coagulation of endometriomas (chocolate cysts)
  • Surgical treatment of ectopic pregnancies
  • Tubal anastomosis (reversal of tubal ligation)
  • Restoration of disrupted tubal-ovarian relationship
  • Hysterectomy (removal of the uterus) and oophorectomy (removal of the ovaries)
  • Surgical procedures for all types of female genital cancers

The hospital stay after laparoscopic surgery is usually very short, and one day is generally sufficient. Sometimes laparoscopic surgery is combined with hysteroscopic surgery.

The combined use of these two methods may be required, especially in cases of uterine anomalies.

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