In the past 35 years, laparoscopic surgery has developed from a limited procedure for tubal ligations and diagnosis into a common surgical procedure that can treat multiple gynecologic conditions. If a reproductive problem is diagnosed during a laparoscopy procedure, the issue can usually be corrected during the same procedure.
Reproductive problems that can be corrected with laparoscopy include removing fallopian tube and ovarian adhesions, removing ovarian cysts, opening blocked fallopian tubes, and treating ectopic pregnancy. Endometriosis, a common cause of infertility, can also be removed or treated if implanted on the outside of the uterus, ovaries, or abdomen, and fibroids in the uterus can also be removed. Additionally, laparoscopic surgery can be used to remove diseased ovaries and assist in the performance of a hysterectomy.
During a laparoscopy operation, two or three incisions are made to accommodate the laparoscope and additional instruments, such as probes, biopsy forceps, scissors, grasping instruments, laser, electrosurgical instruments, and suture materials. The choice of instruments and technique depends on many factors including the location of the problem, the physician’s experience, and availability of equipment.
Multiple studies have shown that laparoscopy is safer, less expensive, and has a shorter recovery time than laparotomy – a procedure that is performed by making an incision several inches long along the bikini line or in an “up and down” alignment to open the abdomen. Laparotomies are still performed for many gynecologic operations, generally when more extensive damage within the abdomen requires an enlarged space for the surgeon to operate. Laparotomy surgery requires longer recovery than laparoscopy, with the patient remaining in the hospital for several days and being required to wait two to six weeks before returning to a regular level of physical activity.
However, while laparoscopy has many advantages over laparotomy, some types of surgeries may be too risky to perform via laparoscopy, and in some cases it is not clear if laparoscopy yields results equal to the results of laparotomy. The patient should discuss the pros and cons of each procedure with her doctor before proceeding.
Though minimally invasive, there are risks associated with laparoscopy:
Serious laparoscopy complications are rare. If there is damage to the bowel, bladder, ureters, uterus, major blood vessels, or other organs, additional surgery may be required. Injuries can also occur from insertion of the various instruments used during the procedure.
Certain conditions, such as previous abdominal surgery (especially bowel surgery), severe endometriosis, a history or presence of bowel/pelvic adhesions, pelvic infections, obesity, or excessive thinness may increase the risk of serious complications.
Allergic reactions, nerve damage, and anesthesia complications rarely occur. The risk of death due to a laparoscopic surgery is very small (around 3 in 100,000). The chance of any complication occurring is only about one or two in 100 woman, and these are usually minor.
Laparotomy carries the general risks of surgery and use of anesthesia. Additional risks associated with laparotomy vary depending on the underlying problem or disease that the procedure is meant to treat.
Risks specific to the procedure are: