Laparoscopic surgery, also known as ‘minimally invasive’, or ‘keyhole surgery’, is a method that has revolutionised all areas of surgery including gynaecology and some cancer operations.
It is performed using very small incisions in the abdominal wall, which allows a high definition camera to give very clear pictures of the female pelvic organs and abdomen.
Laparoscopic surgery allows almost any procedure that is usually performed with a large incision (laparotomy) to be done with small incisions (usually less than 1cm). Laparoscopy is used to find problems such as cysts, adhesions, fibroids, and endometriosis. It is also used successfully for removal of some cancers (eg uterine cancer) and lymph nodes. Tissue samples can be taken for biopsy through the small ports placed in the abdominal wall.
Dr Farrell has extensive training and experience using laparoscopic surgery for both benign and cancerous conditions. She is happy to discuss with you, which cases can be treated very successfully with the laparoscopic approach. Prior surgery and obesity are not contraindications for laparoscopic surgery.
The benefits of laparoscopic surgery are smaller surgical scars, reduced blood loss during surgery, less pain following surgery, shorter hospital stay, and faster return to normal activities.
Dr Farrell has a special interest in this method and has performed thousands of these minimally invasive procedures. Unfortunately many patients are still undergoing laparotomy throughout Australia for procedures that could be performed safely and successfully as a laparoscopic procedure with all its inherent benefits.
A laparoscopic procedure may take between 30 minutes for a simple diagnostic procedure and up to 3-4 hours for a complicated cancer procedure. Patients with history of adhesions tend to have longer procedures. On average, a total laparoscopic hysterectomy procedure takes around 90 minutes.
In some cases of gynaecological cancer (endometrial/uterine cancer, and some cases of early cervical cancer), lymph node removal is required for staging (to see how far the cancer has spread) and treatment planning. Dr Farrell offers a new approach called sentinel lymph node removal where appropriate. This is a procedure where special dye is injected into the cervix, and 1-2 lymph nodes from each side of the pelvis are identified by using a special camera, and removed. These lymph nodes are the first lymph nodes to drain the cancer, and if they are negative for cancer cells there is a very high possibility that other lymph nodes will not have cancer cells in them and they will not be removed. By removing a smaller number of representative lymph nodes in this way, the risk of lymphoedema (permanent swelling in the legs) is reduced significantly. Dr Farrell will discuss the option of this treatment with you if this is appropriate. It can almost always be performed with a laparoscopic approach.
Most patients do not require extra (adjuvant) treatment, but those that have high risk features on review of all pathology in our multidisciplinary tumour board or with spread away from the uterus noted at the time of surgery will generally be advised to have additional treatment which may consist of chemotherapy and or radiotherapy and or hormonal therapy. The majority of patients treated for uterine cancer are cured of their disease.
Laparoscopy is a common and safe procedure. More than 25000 gynaecological laparoscopy procedures are performed in Australia every year.
Large studies show that the rate of all complications in laparoscopy is less than 1% (1 in 100), with the rate of major complications less than 0.5% (1 in 200). It is important to understand that all operations have some degree of risk. The most important way of decreasing the risk of surgical complications is to have it performed by an experienced surgeon such as Dr Farrell who has been well trained and has extensive experience in the procedure.
Your wounds will be sutured with a dissolvable suture material and therefore no stitches are required to be removed. Occasionally the suture material can become irritating and poke out of the skin. The sutures will eventually dissolve but can be removed if they are causing discomfort. If the wound becomes red or any pus discharges from the wound you will require antibiotics for a wound infection. Once the wound is healed, you are recommended to apply a moisturizer (eg: sorbolene with glycerine, Bio-oil) twice daily for 2-3 months.
When you wake from the anaesthetic, it is normal to feel disoriented and sleepy. Some patients will experience nausea or vomiting, but these feelings should pass quite quickly.
There might be some pain at the site of the incisions, and you will commonly be given analgesics (pain-relieving medication). The carbon dioxide gas used during laparoscopy may sometimes cause a sensation of bloating in the abdomen and pain in the shoulder tips.
Depending on the complexity of surgery and the length of the operation, you will feel tired and have abdominal discomfort for a few days. There may also be some vaginal bleeding, particularly if there has been a hysteroscopy or curette procedure performed at the same time.
You will be given instructions about dressings over the wounds, and the stitches used to close the incisions.
Dr Farrell normally reviews patients in her rooms at 10 days post-surgery, and then again at about 6 weeks. The cost of both visits is fully covered by the surgical fee.