Gynecologic surgery is performed as minimally invasive surgery. Specialized surgeons perform the surgery by making 1 to 4 small incisions—each about 0.5-1 cm in size—or use an existing orifice, depending on the type of surgery. After that, cameras and instruments are used to perform the surgery on the uterus, ovaries, or fallopian tubes, and the images will be displayed on a screen. Because the images displayed from laparoscopic surgery are magnified, laparoscopic surgery is highly accurate and safe. Presently, there is even 3D laparoscopic surgery technology, further increasing accuracy.
Two Types of Minimally Invasive Gynecologic Surgery
- Laparoscopic surgery is where a thin, flexible tube with a video camera, called an endoscope, is inserted through a small incision. Tiny surgical instruments are used to perform the surgery inside the abdomen.
- Hysteroscopic surgery is where a thin, lighted tube, called a hysteroscope, is inserted through the vagina and cervix into the cavity of the womb to diagnose and surgically remove any abnormal growths on the uterine wall.
Comparing Scars from “Laparoscopic Surgery” and those from “Open Abdominal Surgery”
The incision from open abdominal surgery is approximately 8-10 cm in size, while laparoscopic surgery requires only 1 to 4 incisions that are about 0.5-1 cm in size. Comparing these two types of surgery, laparoscopic surgery has the following advantages:
- The surgical incision is small. The scars from the surgery are therefore smaller, as well.
- The patient can move, sit up, or walk relatively quickly after surgery, meaning the hospital stay is shorter.
- The recovery period after surgery is relatively short, so the patient can return to daily life faster.
- Excessive scarring, known as fibrosis, occurs less often.
Minimally invasive gynecologic surgery can be summed up as: “Smaller incision, faster recovery, so you can go home and get back to work faster.”
In general, about 80 percent of patients undergoing gynecologic surgery can use a minimally invasive or laparoscopic technique. The laparoscopic surgery center at Bangkok Hospital Khon Kaen has adopted modern small incision surgery technology, called Advanced 3D Laparoscopic Surgery, which helps increase the accuracy by allowing the surgeon to see a clear and detailed picture. The surgeon can make precise measurements, almost like going inside the patient’s abdomen. This helps surgery to be safe and fast. The surgical incisions are small, reducing wounds, which is important to help patients to recover faster, especially those with menopause. It also reduces complications from the surgery and avoids unsightly abdominal scars. Finally, by using a 3D Hi-Definition camera, the sharper images allow for lower occurrences of infection and blood loss.
Additionally, the laparoscopic surgery center at Bangkok Hospital Khon Kaen has incorporated a technology called Single Incision Laparoscopic Surgery (SILS), in which patients undergoing surgery will have a single surgical incision on the navel, avoiding unsightly wounds. Thus, the patient will not need to have a Natural Orifice Translumenal Endoscopic Surgery (NOTES). As a result, the patient will experience less pain and recover quicker.
Gynecological Conditions Eligible for Laparoscopic Procedures
- Uterine fibroids
- Ovarian cysts or tumors
- Ovarian endometrioma (chocolate cysts)
- Chronic pelvic pain
- Infertility
- Ectopic pregnancy
- Chronic anovulation
- Female tubal sterilization
- Gynecological Conditions Eligible for Hysteroscopic Procedures
- Uterine polyps, adenomyosis, abnormal uterine bleeding, and others
“Minimally invasive surgery can be used to treat almost all conditions, but not in every patient. It depends on the presentation of the condition and the constraints of the given surgical method. Therefore, it is necessary to have a doctor individually evaluate each patient. The doctor will give advice on ways to treat the condition that are appropriate for the patient, as well as help each patient to understand the risks and benefits in order to make an informed decision. Regardless of what kind of surgery is proposed, the patient needs to be in good health and without any conditions that would be risky to surgery, such as respiratory disease, heart disease, or shock. And, the most appropriate treatment will depend on the age, symptoms, severity of disease, and the desire to have children in the future.”
