laparoscopic surgery Dr Molloy's second major interest is performing gynaecological surgery using the laparoscope. This is called minimally invasive surgery.
Dr Molloy performed the first laparoscopic hysterectomy in Queensland in 1990. He teaches laparoscopic surgery to other specialists at regular workshops and courses both nationally and internationally. He is Director of the Queensland Gynaecological Endosurgery Group.
FACTS ABOUT LAPAROSCOPIC SURGERY
A laparoscope is a telescope which can be inserted into the abdominal cavity through a small incision. A powerful light source and a TV camera means the surgeon can see the abdominal and pelvic organs more clearly. The video camera is connected to a high resolution viewing screen to optimize vision during the operation. The surgeon can then manipulate the laparoscope and other instruments outside of the patient's body to perform most gynaecological operations. Because the image is magnified the surgeon can see areas of disease more clearly and can more easily prevent bleeding during surgery. Laparoscopic surgery can be diagnostic eg. for infertility or pelvic pain. It can also be used in a therapeutic way to perform most gynaecological operations instead of the same operation through a large incision. The alternative to laparoscopic surgery is the traditional or open technique using a larger incision.
The advantages of this form of surgery are:- Less pain post-operatively
- Smaller cuts (only 5mm)
- Faster recovery and discharge from hospital
- Quicker return to normal activity and lifestyle
- Hysterectomies
- Removal of fibroids
- Ovarian cyst removal
- Removal of tubes or ovaries
- Pelvic Floor Repair for prolapse
- Bladder neck suspension for incontinence
- Removal of Endometriosis
- Infertility Surgery
HOW IS IT DONE?
The patient is put to sleep under a general anaesthetic. A small incision is made in the umbilicus. A needle will often be inserted into the abdominal cavity to insert CO2gas.This will create a working space in the abdomen. A larger cannula is then inserted so the laparoscope with the attached light source and video camera can be introduced and used. Up to 3 other small incisions will be made to allow other instruments such as scissors, forceps and diathermies to be used. These incisions are usually only 5mm long. The agreed operation is performed. At the end of the operation a careful check is made to make sure that all is well and there is no bleeding. The small wounds are then closed. The patient wakes up in the recovery room before transfer back to the ward.
RECOVERY
This will be dependent on a large number of factors, the most important of which is the type of operation performed. It is important to discuss this with your surgeon prior to the procedure. In general, recovery after laparoscopic surgery will be quicker than after the same operation done through a large cut.
RISKS OF LAPAROSCOPIC SURGERY
- The most important risk is that of damage to a loop of bowel or a major blood vessel at the time the laparoscope is inserted through the small incision into the abdominal cavity. This can be a cause of serious infection or bleeding. Many of the ongoing problems from this complication can be reduced by early diagnosis and prompt treatment. This risk is quoted at 3 cases per 1000 laparoscopies.
- The CO2 can enter a vein and disrupt the rhythm of the heart. This is fortunately very rare (1 in 25,000-30,000 cases) but can be serious if it does happen.
- There are additional risks relating to whichever operation is done using the laparoscope. These are usually no higher than if the same operation was performed through a larger incision and would be experienced by the patient whatever approach was used to perform the surgery.
- A general anaesthetic carries a series of individual risks dependent on the age and medical history of the patient. These will need to be discussed with your anaesthetist.
- On the positive side laparoscopic surgery reduces the risk of a wound complication. These are the most common complications of surgery when done through a large incision. Wound haematoma and infection do occur with small laparoscopic incisions but are uncommon (1-3% ie. 1-3 per 100 cases).
QUESTIONS TO ASK
Is the surgeon familiar with the laparoscopic technique and the operation?
Can my operation be carried out using a laparoscopic approach?
Will the operation relieve my symptoms?
How painful is the operation?
How long is the recovery period?
What are the risks associated with the operation and the laparoscopy?
How many cases of my type has the surgeon/unit performed previously?
Is there written information about this procedure?
Recent Past Posts
President - Australian Gynaecological Endoscopy SocietyChairman - IVF Director Group of Australia and New Zealand
President - National Association of Specialist Obstetricians and Gynaecologists