Often called ‘belly button surgery’, laparoscopic surgery involves small (1/4 inch) incisions in the abdomen (usually three) through which major surgical procedures can be performed. The first of these incisions is made in the umbilicus (“belly button”). A laparoscope (something like a telescope) is placed through this incision and attached to a small video camera. The video image is viewed on a HD TV monitor in the operating room. By moving the laparoscope closer to the pelvic organs, magnification up to 6 X can be achieved.
After the laparoscope is placed through the umbilicus, two or three other small (1/4 inch) incisions are made in the abdomen, usually in or near the pubic hairline. Electrodes, lasers, instruments and sutures are passed through these incisions to complete the operation. These instruments are very small (from 1.5 to 4.5 millimeters in diameter).
The combination of small instruments and magnification enable surgical precision that is almost impossible to achieve at laparotomy. By comparison, there is no magnification of the operative field during laparotomy, and the surgeon’s hands and large surgical instruments obscure the operative field. The precision attained during laparoscopic surgery becomes extremely important when the gynecologist is treating endometriosis, adhesions, ovarian masses, and gynecologic cancer.
By comparison, laparotomy (the technique by which most gynecologic procedures are accomplished) involves an incision in the abdomen usually measuring 5 to 11 inches long. This incision is horizontal (the so-called “bikini” incision) or vertical (from the pubic bone to the belly button). This large incision is required for gynecologists to use standard surgical instruments. This significantly larger incision is associated with a much longer recovery, more postoperative pain, longer hospital stays, and more potential complications than the same procedure performed by laparoscopic techniques.
The advantages of laparoscopic surgery over conventional laparotomy are unquestioned. Most patients undergoing laparoscopic surgery are dismissed the same day, although a few may require an overnight stay in the hospital. Recovery (return to normal activity) from laparoscopic surgery is 3 to 5 weeks shorter than comparable procedures performed at laparotomy. Patients experience less postoperative pain, shorter and more comfortable recovery, outcomes are at least as good (if not better), and costs to the healthcare system are less when gynecologic surgery is performed using laparoscopic techniques.
Why are so few major gynecologic procedures performed laparoscopically? The answer is relatively simple. Major laparoscopic surgical procedures are difficult for most gynecologic surgeons to master. The gynecologist must perform many simple laparoscopic procedures to develop the skill necessary to perform the more complex surgeries. They must perform these procedures on a regular basis to develop and maintain expertise. Unfortunately, the average gynecologist in the United States performs only one surgical procedure each week, a case load insufficient to develop or maintain skills necessary to perform the more advanced (complex) laparoscopic procedures. As a result, unfortunately, most gynecologic surgeries for benign disease are still performed abdominally, although experts throughout the country agree that the vast majority could safely and efficiently be performed laparoscopically.
