Laparoscopy

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Dr Nikam and A/Professor Chan both hold the highest level of qualifications and accreditation for Gynaecological Laparoscopic Surgeons (RANZCOG Level 6).

The Australian & New Zealand College of Obstetricians & Gynaecologists (RANZCOG) & the Australian Gynaecological Endoscopic Society (AGES) have developed specific criteria regarding the level of credentialinga specialist gynaecological surgeon in laparoscopy must achieve before performing complex operations. For example, only a Level 6 Credentialed Surgeon should perform operations for complex Stage 4 Endometriosis.

Almost all major operations can be performed by Laparoscopy, including Hysterectomy (removal of the womb), Myomectomy (removal of fibroids), Excision of Endometriosis and repair of Prolapse.

At AEVAFEM, both Dr Nikam and A/Professor Chan will be able to discuss and offer you the best possible surgical approach, should you ever need a surgery.

Laparoscopic Surgery is performed under general anaesthesia. Tiny incisions are made in the patient’s abdomen to perform the surgery.

Gas (carbon dioxide) is used to expand the abdominal cavity so Dr Nikam & A/Professor Chan can perform laparoscopy with a pencil-thin instrument called a laparoscope. It has a powerful light and a miniature camera that sends images of the surgical field to a high definition video monitor above the operating table.

The tiny incisions are usually placed through the umbilicus (belly button) for the laparoscope and additional accessory incisions in the abdomen are utilized, allowing slim operative instruments to be inserted.

Laparoscopy is used to diagnose and treat many different gynaecological conditions. At the conclusion of the surgery, the instruments are withdrawn, the gas released and the tiny incisions are closed with dissolvable sutures or skin glue (no sutures) below the skin

Laparoscopy is called minimally invasive surgery because the incisions are small (5mm – 12mm). Other non-technical names for the procedure are “Keyhole Surgery” and “Belly Button Surgery”.

There is good evidence from medical research that a Laparoscopic technique has significant benefits for the patient (compared with traditional Open Laparotomy approach). It has been proven. These benefits include:

  • Reduced post-surgical pain
  • Reduced risk of infections and wound complications
  • Reduced risk of post-operative adhesions
  • Reduced risk of incisional hernia
  • Increased comfort following surgery
  • Reduced need for analgesia & pain relief
  • Reduced hospital stay
  • Faster return to normal physical activities
  • Faster return to work
  • Improved cosmesis

Most patients can be discharged on the same-day or next-day and can return to their normal lives much more quickly than after an open (laparotomy) surgery procedure.

The surgeon’s experience and level of training plays a crucial role in deciding whether Operative Laparoscopy or Laparotomy should be performed. While most surgeries can be done safely by Laparoscopy, some surgeries are better suited via the open approach, especially when cancer of the pelvic organs is suspected.

Every patient is different and has different goals – at AEVAFEM, we discuss all relevant approaches and ensure that you are a part of the decision-making process so we can achieve the best possible outcome.

Common Surgery Questions

Laparoscopic procedures involve 3 to 4 tiny cuts (5 – 12 mm) in the abdomen. This allows the use of specialised instruments and a small camera inside the abdomen. The entire abdomen, pelvis, uterus and ovaries can be seen on a high definition video screen.

A laparoscope is a fibre-optic telescope designed to allow the surgeon to visualise and examine the organs lying within the pelvic and abdominal cavities and perform operative procedures.

Laparoscopy allows all manner of procedures to be performed without the need for a large skin incision and minimal handling of internal tissues.

This typically results in:

  • less pain
  • faster recovery
  • minimal scarring
  • earlier return to normal activity
  • reduced risk of infection

Furthermore, it decreases the risk of:

  • infection
  • formation of adhesions
  • incisional hernia

The operation is performed under general anaesthesia. The laparoscope is passed into the abdomen via the belly button to visualise the surgical operative field. Slim instruments are inserted via the other tiny cuts to complete the surgery. The incisions are closed with surgical skin glue (no sutures) or with dissolvable sutures below the skin.

Almost all procedures are now amenable to laparoscopy. However, a larger incision on the abdomen (Open Approach/Laparotomy) may sometimes be necessary, particularly where large masses are present or cancer is suspected.

Laparoscopy can be used to investigate and diagnose

  • causes pelvic pain
  • potential causes of infertility
  • examination of ovarian cysts and tumours
  • to obtain biopsy samples
  • to investigate suspected ectopic pregnancy

Common procedures include:

  • Female sterilisation
  • Treatment of ectopic pregnancy
  • Release/remove pelvic or abdominal adhesions
  • Treat of endometriosis
  • Excision of ovarian cysts
  • To enhance fertility and assisted reproductive techniques
  • Myomectomy (removal of fibroid)
  • Hysterectomy (removal of Uterus)
  • Reconstruct the pelvic floor, treat prolapse and incontinence

No surgical procedure is entirely without risk, but this type of surgery attempts to minimise such risks. The specialists at AEVAFEM will discuss all relevant risks associated with the procedure when you consent for the procedure. Laparoscopic surgeries are performed under General Anaesthesia. The Anaesthetist will address the risks associated with your anaesthesia. Severe obesity or cigarette smoking increases your overall risk.

In particular, every surgery has the risk of infection, bleeding, injury to surrounding organs and risk of clot formation in the legs and lungs (Deep Vein Thrombosis & Pulmonary Embolus). Our specialists will take evidence based precautions to minimise these risks, such as giving antibiotics, use of calf compressors and anti-coagulants (blood thinning agents) to prevent clots. If a complication does arise, it will be dealt with as soon as practicable and rarely leaves any long-term sequelae.