Minimal Access Surgery (MAS) is a modern surgical technique in which operations are performed via abdomen / tummy through small incisions (usually 0.5–1.5 cm). Minimal Access Surgery (MAS) is also known with various other names i.e. Laparoscopic surgery (Most common), Minimally Invasive surgery (MIS), Band-Aid surgery, or keyhole surgery.
Minimal Access Surgery is performed with the use of sophisticated medical grade cameras, telescopes and surgical instruments. In another words, Minimal Access Surgery is an another way of performing surgery in which the surgical steps remain the same but it’s being performed with special instruments with least abdominal scars. With the use of specific telescopes and camera the anatomy of body organs is visualized with magnification. Magnified surgical field makes surgical steps easy.
What are the advantages of Minimal Access Surgery?
Laparoscopy has a number of advantages to the patient compared to the more common, open surgical procedure.
Smaller incisions: Incisions given for laparoscopic surgery are small (usually 0.5 cm – 1.5cm).
Lesser pain in post-operative period: Smaller incisions reduce pain after surgery.
Early Recovery: Lesser pain after surgery fastens the recovery process and faster return to everyday living.
Lesser Pain Medication: Reduced pain after surgery amount to lesser medication for pain after surgery.
Shorter hospital stays: Because of early ambulation and faster recovery average hospital stay remains 1 to 2 days for laparoscopic surgery (versus 5 to 7 days for open surgery).
Lesser wound infection and hernia formation: Smaller incisions decrease the risk of wound infection and chances of hernia formation.
Cosmetically acceptable: Smaller incisions result in less scarring and hence cosmetically acceptable scars.
Reduced chances of Infections: There is reduced exposure of internal organs to possible external contaminants which reduces the risk of acquiring infections.
Reduced hemorrhage: The amount of blood loss is lesser during laparoscopic surgeries which reduces the chance of needing a blood transfusion.
What is the usual stay at hospital?
Usual stay at hospital varies from 24 hours to 2 days. Once planned for laparoscopic gynecologic surgical procedure it is advisable to stay in hospital one day prior to surgery. On this day a specific protocol of medicines and preparation for surgery is conducted. After surgery the sooner patient starts ambulation the sooner she gets discharge from the hospital.
What all diseases in Gynecology can be treated with Minimal Access Surgery?
AUB / DUB (Abnormal / Dysfunctional Uterine bleeding) which is not responding to medicinal treatment: Abnormal / Dysfunctional Uterine bleeding is due to abnormality in endometrium of uterus which usually responds to medicinal treatment. In cases where medicine is not able to control the symptoms, medicines are contra-indicated etc uterus, along with both fallopian tubes +/- ovaries, can be removed laparoscopically.
Fibroid Uterus: Uterine fibroids troubling in the form of abnormal bleeding, painful periods (dysmenorrhea), causing recurrent miscarriage / abortion, causing infertility etc. usually need surgical removal and can be removed laparoscopically.
Ovarian Cysts: Most of the ovarian cysts disappear spontaneously in 1-2 months after detection. Ovarian cysts which persist for long time, are suspicious of cancer, symptomatic can be removed laparoscopically.
Endometriosis: Endometriosis can present as ovarian endometrioma (Ovarian cyst or chocolate cyst), endometriosis implants in pelvis, Adhesions in pelvis involving uterus, fallopian tubes, ovaries, intestinal loops, rectum etc. All these entities can be treated laparoscopically.
Uterus Prolapse / Vault Prolapse / Pelvic Organ Prolapse: Uterus prolapse into vagina, vaginal vault prolapsing into vagina after hysterectomy can be treated with laparoscopic surgery.
Uterine cancer, Uterine cervix cancer: Cancers of uterus, uterine cervix, ovarian cancers after chemotherapy can be treated with laparoscopic surgery in which tumorous tissue can be removed with more precision.
Ectopic pregnancy: Extra uterine pregnancy e.g. pregnancy in fallopian tube (tubal pregnancy), pregnancy in ovaries (ovarian pregnancy), pregnancy in cervix (cervical pregnancy) can be treated with laparoscopic approach, as per the indications.
Ovarian Torsion: Due to numerous factors ovarian tissue twists around its own axis which leads to compromise in its blood supply ultimately leading to infarction of ovarian tissue. Laparoscopically ovaries can be untwisted and fixed to prevent further twisting.
Recurrent Miscarriage with incompetent cervix: With the incompetent cervix there are chances of recurrent miscarriage. Few cases of incompetent cervix need cerclage from abdomen which can be performed through laparoscopic approach.
Blocked fallopian tubes: Fallopian tubes might get blocked due to infections, adhesion or pressure from mass. In few cases there is requirement of tube opening in cases of tubal sterilization. All these fallopian tube blocks can be opened with laparoscopic surgery.
What Gynaecology Surgeries can be performed laparoscopically?
Total Laparoscopic Hysterectomy (commonly called as TLH): For the indications e.g. AUB / DUB, chronic cervicitis, chronic pelvic pain etc uterus along with both fallopian tubes or uteri along with both tubes and ovaries is removed with the procedure named
Laparoscopic Myomectomy: Fibroids in uterus can be removed laparoscopically. Fibroids troubling in the form of abnormal bleeding, painful periods (dysmenorrhea), causing recurrent miscarriage / abortion, causing infertility etc. usually need surgical removal.
Laparoscopic Ovarian Cystectomy: This procedure is meant for removing a symptomatic ovarian cyst. The normal ovarian tissue is preserved in this procedure.
Laparoscopic Oophorectomy: In cases of ovarian mass one or both of the ovaries are removed laparoscopically.
Laparoscopic Surgery for Endometriosis: In cases of endometriosis of ovaries, endometriosis implants in pelvis surgery can be performed to remove endometriosis.
Laparoscopic Procedures for Pelvic Organ Prolapse: Uterovaginal prolapse can be treated with laparoscopic surgery.
Laparoscopic Radical Hysterectomy with pelvic / para aortic lymph adenectomy: For cervical cancer and uterine cancer uterus surrounding tissues are also removed for proper clearance of cancerous tissue. This surgery is done for cervical cancer cases
Laparoscopic Salpingectomy: laparoscopically, Ectopic Pregnancy can be treated (surgically removed) from fallopian tube, ovary.
Laparoscopic surgery for ovarian torsion: Ovarian torsion occurs in enlarged ovary and most commonly in cases of ovarian dermoid cyst. This is an emergency and if not operated and normalized this can jeopardize the ovary.
Laparoscopic Cervical Cerclage: In cases of cervical incompetence when the vaginal cervical cerclage has failed in the previous pregnancy, Laparoscopic cervical cerclage is indicated. We prefer to do this surgery in the inter pregnancy period.
Laparoscopic Tuboplasty: In Cases of infertility with tubal pathology, block and adhesions, tuboplasty opens the fallopian tube and restores the anatomy.