In gynecology, laparoscopic surgery is used for many precedure that was traditionally performed via laparotomy. These procedures are performed for benign and malignant diseases.
Potential advantages of laparoscopy over laparotomy;
Shorter operative time for some.
Decreased adhesion formation.
In diagnostic lap., the surgeon will be able to see signs of a diseases or condition ( endometriosis, adhesions, ovarian cysts immediately).
In the therapeutic laparoscopy, the ovarian cysts, diseased uterus or cervix, missed intraabdominal loop, ectopic pregnancy, or removal of twisted Adnexa.
Morbidity & Mortality rate.
complications from laproscopic surgeries in the overall complications rate of laparoscopy is 5.7/1000 procedures.
Mortality rate is 0.05%.
The overall risk of minor complications (e.g. fever, wound or urinary tract infection) was lower in women undergoing laparoscopic procedures.
In comparison, both groups had the same risk of major complications, such as pulmonary embolus, blood transfusions, fistula formation, and major additional unplanned surgery.
Abdominal Access Sites:
Gynecologic laparoscopic access is commonly through paraumilical area, frequently using a veress needle for insufflation followed by tracer placement.
Instruments and devices used in lap. surgery include the Tawer which contain the camera and its screen, electrosurgical unit, light source, suction irrigation machine, instrument for the entry and surgery.
PREOPERATIVE EVALUATION AND PREPARATION.
Medical comorbidities that impact homeostasis or the ability to tolerate surgery e.g. asthmatic or cardiac diseases.
Risk factors for adhesive disease or umbilical or ventral hernial repair.
These may impact the choice of site of laparoscopic access and increases the risk of complications related to laparoscopic entry. In addition, extensive pelvic adhesions may increases the likelihood of conversion to laparotomy and this possibility should be included in the informed consent for the operation.
Appropriate preoperative testing, include pregnancy testing in the reproductive age women. Antibiotic and thromboprophylaxis.
Bowel preparation is no longer standard practice prior to gynecologic surgery.
Removal of umbilical jewellery is required prior to lapaoscopic surgery.
Patient positioning and preparation:
The women is placed in a supine or dorsal lithotomy position for laparoscopic surgery.