What is laparoscopy?

Laparoscopy means to observe in Greek. The thoracoscopy is called cystoscopy if the observed site is a thoracic cavity, and hysteroscopy if it is inside the uterus.

Laparoscopy is a semi-invasive surgical technique used to examine or operate organs and tissues in the abdominal cavity. It takes its name from the laparoscope, which is used during the operation and has a light camera at the end. It is also called keyhole surgery or minimally invasive surgery. It is performed under general anesthesia and by specially trained operator doctors. Laparoscopic surgery was performed first in gall bladder and gynecology operations. In the last 10 years, the field of application of this technique has expanded considerably.

Laparoscopy, which is one of the most important developments integrating the advances in technology and medicine, has become almost the first choice in the diagnosis and treatment of many diseases due to the smaller size of the cameras.

How is laparoscopy performed?

In traditional “open” surgery, the surgeon uses a single, large incision to enter the abdomen. In laparoscopic surgery, several incisions with multiple diameters (0.5 – 1 cm) are used. Each cut is called a “port.. A tubular instrument known as a trocar is placed in each port.

During the procedure, special instruments and a special camera called laparoscope pass through the trocars. At the beginning of the procedure, the abdomen is inflated with carbon dioxide gas to provide the surgeon’s working and imaging field. Laparoscopy transmits images from the abdominal cavity to high-resolution video monitors in the operating room. During the operation, the surgeon monitors detailed images of the abdomen from the monitor. This system allows the surgeon to perform the same procedures as conventional open surgery with fewer incisions.

In some cases, the surgeon may choose to use a specific port type large enough to handle manually. When a hand port is used, the surgical technique is called “hand-assisted ar laparoscopy. The incision required for the hand port is larger than other laparoscopic incisions, but smaller than that required for conventional surgery.

The basic instrument in laparoscopy is a miniature telescope. The procedure is performed under general anesthesia. After the patient sleeps, the necessary regional antiseptic cleaning is performed. The patient is covered with sterile drapes. The procedures to date are the same as for conventional surgical procedures.

Only after the patient goes to sleep is he placed in the lithotomy position (the position of the patients during the gynecological examination). Then, a long and thin needle called the verres needle is inserted through the navel into the abdominal cavity and carbon dioxide gas is introduced.

The aim here is to push the intestines by inflating the abdominal cavity with gas and to create a suitable room for the procedure. Approximately 2-3 liters of gas is sufficient for this purpose. A 1 cm long incision is then made into or just below the navel.

From this incision, a 10 mm wide tube called the trocar is placed in the abdominal cavity. An illuminated telescope is placed through this pipe. It can be viewed directly from the eye or by observing the monitor by placing a camera behind the telescope.

Observation is made after the telescope is placed. In order to work comfortably during observation, a manipulator is inserted into the uterus via vaginal route. An assistant can move the uterus in various directions with this manipulator.

In addition, this device can also be used to determine whether the tubes are open by introducing fluid into the uterus. From these trocar, special instruments are placed and operations are performed.

When the operation is over, all tools are removed. Check for bleeding. The gas in the abdomen is discharged as much as possible. The incisions are then repaired.

These cuts are either glued with special patches without any stitches or self-melting aesthetic stitches that are not visible from the outside.

The patient is discharged after being kept under observation for 6-8 hours and 24 hours depending on the operation.

When is laparoscopy performed?

Laparoscopy is not only a method applied by the obstetrics branch. However, women are most preferred for birth problems. In the field of gynecology, it is a method that can identify the cause of infertility of the woman, treat the cause of infertility, reach intrauterine problems, treat them, and even remove the uterus and reveal successful results in cancer treatments. It is used in the detection of infertility problems among obstetrics patients. Endometriosis is a well-known method of diagnosis and treatment, which is related to infertility due to ovarian problems, intrauterine adhesions, fibroids and ectopic pregnancy.

In which health problems is laparoscopy preferred?

Oncological types of surgical procedures

Ectopic pregnancy

If the uterus needs to be removed

In the presence of endometriosis

Diagnosis and treatment of tubular problems

If it is considered necessary to connect the tubes

If there are adhesions on the inner abdomen

Fibroids and polyps

It may be considered if there is abscess in the pelvic condition.

Types of laparoscopy

Laparoscopic procedures are divided into diagnostic laparoscopy and laparoscopic surgery:

Diagnostic laparoscopy: It is performed for the diagnosis of a disease with no cause.

Laparoscopic surgery: Laparoscopic surgery is used for the treatment of a disease determined by examination and imaging techniques.

Laparoscopy Videos

Laparoscopic Ovary and Tube Removal

Laparoscopic Endometrioma Cyst Excision – Removal of Chocolate Cyst

Laparoscopic Myomectomy

Total Laparoscopic Hysterectomy

Where Laparoscopy is Used

Laparoscopy or L / S in short is advantageous because of shorter hospital stay, smaller incisions and a much shorter recovery period than classical surgery. These scopy techniques, which are used by almost all surgical branches, are performed in two types as diagnostic and therapeutic. As the name suggests, no additional surgical procedure is performed during diagnostic laparoscopy, but the causes of the patient’s complaints are investigated with observation. In fact, whether a laparoscopy is diagnostic or not can be told after laparoscopy. Because when you start laparoscopy, if you need to do additional surgery for the benefit of the patient, you will not postpone it and you will do so at the moment. Infertility is the most commonly used field in gynecology.

Infertility
In cases of unexplained infertility, L / S is performed to assess whether the tubes are open, the presence of any adhesions, and the condition of the ovaries. During the procedure, a liquid called methylene blue is given vaginally to determine whether it passes through the tubes, if there is a passage, whether this passage is healthy or not, ie the presence of easy or difficult passage. In cases where the transition is problematic, correction of the canal (tubes), if possible, can be performed to ensure re-pregnancy.

Acute or chronic groin pain
Another diagnostic use of laparoscopy is to investigate the causes of chronic groin pain in unexplained cases. If any pathology is detected during L / S, an attempt may be made to do so. In cases where no pathology can be detected, presacral neurectomy can be used to relax the patient by removing the nerve fibers at the transition point of the pelvic nerve sensations. It is a difficult operation because it is close to large vessels such as the aorta and vena cava.

Tubal Ligation and Tubal Reanastomosis
Laparoscopy is the first and most commonly used field interventionally to connect the tubes to prevent pregnancy. It is very advantageous compared to open surgery. In some patients who have already tied their tubes but regret their decision, the tubes can be restored by laparoscopy.

Ovarian cysts
 Most simple kits can be removed by laparoscopy. During the L / S, only the cyst can be removed by leaving the ovary. This should also be the goal in patients of childbearing age.

Polycystic ovary
L / S can be performed both for the detection and treatment of polycystic ovary. If polycystic ovary is detected during L / S, ovarian surface can be pierced from multiple areas to facilitate ovulation (drilling). Yet another method is the wedge removal of a portion of the ovary.

Endometriosis
Endometriosis patients are the leading groups of patients who benefit most from laparoscopy. Endometriosis is diagnosed by L / S, its severity is determined and endometriotic foci are burned and treated. Chocolate cysts are also removed during this process or the cyst walls are burned after their contents have been emptied.

adhesions
L / S may be preferred for the removal of adhesions due to previous operations or infections.

Ectopic pregnancy
Laparoscopy can be used in surgical treatment of ectopic pregnancies, whether complicated or not.

myomectomy
In appropriate cases, subserous and intramural fibroids can be removed with L / S. Number of fibroids (my 3) and fibroids smaller than 8 cm can be easily removed by experienced surgeons with adequate technical equipment. According to the size of the fibroids removed after the operation, it is recommended that the patient does not conceive for 3-6 months postoperatively.

hysterectomy
L / S guided hysterectomy (removal of the uterus) can be performed. If the ligaments that hold the uterus in place during the surgery are cut and the uterus is loosened, then the procedure is continued vaginally, the whole process is called laparoscopy assisted vaginal hysterectomy (LAVH).

If the entire procedure is performed as laparoscopy, this is called total laparoscopic hysterectomy (TLH).

Gynecological cancer surgery
In some stages of endometrial ovarian and cervical cancers, laparoscopy can be used for removal of the uterus and for removal of lymph nodes that may spill cancer.

Urogynecologic operations (incontinence)
They are used in retropubic operations (Burch Colposuspension) to raise the bladder neck in cases of urinary incontinence due to sagging of the bladder and bladder neck.

Risk Factors in Laparoscopy
Although laparoscopy can be performed in almost all patients, it may be inconvenient or difficult to perform in some cases. These include:

• Severe obesity
• Heart diseases
• Large number of previous abdominal operations
• Pregnancy
• Very large masses filling the abdomen

countable. As the incidence of adhesions is high, especially after previous large abdominal operations, the possibility of injury to the intestines increases when troars are placed.

Therefore, it is necessary to be very careful during L / S in such patients.

Advantages of Laparoscopy
One of the most frequently asked questions about laparoscopy is whether it will create a cosmetic problem. The bikini can be worn after L / S because all incisions are easily concealed and small incisions that heal with little scarring are used. This is perhaps the least important advantage of laparoscopy. Other advantages:

The length of hospital stay is very short. We can send patients who have previously been hospitalized for 1-2 days after hours.
The return to normal life is quick. The patient’s work loss is minimized.
No incision in muscles, only holes
Postoperative pain due to incision site is minimal.
Very low risk of hospital acquired infection
The risk of postoperative complications is minimal
There is very little risk of wound hernia
Does not disturb physiology and anatomy
As the procedure can be videotaped, there is a greater chance of consulting with other surgeons when diagnosis is difficult
In some cases, it provides an easier field of view than open surgery.
Nowadays, almost all gynecological operations can be performed by endoscopic (closed) methods. Since there are many advantages in favor of the patient compared to open surgery, this technique should be the method that patients seek and prefer. If an operation is offered to you as a patient, please ask your doctor about this and whether it can be done with closed method and ask for information.

Complications of Laparoscopy
Even very simple surgical procedures, such as nail pulling, have some complications. Laparoscopy may also have complications.

Complications due to general anesthesia
Injury to structures such as intestine, bladder vein
Blood clot or carbon dioxide enters the circulation causing embolism (congestion)
Infection
Bleeding
pain
Emphysema developing as a result of the gas delivered under the skin and not into the abdominal cavity
Since the carbon dioxide given outside cannot be completely discharged, the gas may push the diaphragm upwards and shoulder pain may occur, especially on the right side, for some time after surgery.

There is the possibility of switching to open surgery at any time during the procedure. This may be a developing complication or because the procedure cannot be performed with L / S.

Laparoscopic Gynecologic Surgery

Laparoscopic Gynecological Surgery In parallel with the developing technology in recent years, new methods have emerged in gynecological operations. In endoscopic operation, organs are made visible by entering into the body with a pipe and necessary surgical procedure is performed. Endoscopy is generally used by many branches.

Since gynecological operations are usually performed into the abdomen, it is called “laparoscopic operation j.

Laparoscopic Cyst Operation

Laparoscopy is frequently used in egg cyst operations. Laparoscopy is used especially in simple cysts, chocolate cysts and egg cysts of unknown origin.

Laparoscopic Uterus Operation

Uterine fibroids, formal abnormalities can be corrected by laparoscopic surgery. In some cases, the uterus and ovaries can be removed by complete laparoscopic surgery.

Laparoscopic Ectopic Pregnancy Surgery

Ectopic pregnancy is a condition in which the pregnancy is not in the uterus, but in tubes or on the egg surface. Causes internal bleeding. Once diagnosed, surgery is required quickly. Laparoscopy (closed) surgery is an appropriate option.

Advantages of Laparoscopic Surgery

It is a more comfortable, less painful operation for the patient. When performed in experienced hands, the operation time is quite short, but it can be quite long compared to open operations. Rather than making a large surgical incision, a maximum of 3 or 4 holes are operated and healing is faster.

However, patient selection is very important for laparoscopic surgery. The procedure may not be suitable for all patients. The general condition of the patient, the characteristic of the gynecological problem and the degree of the disease are decisive factors.

Laparoscopic Gynecologic Surgery Prices

Laparoscopic gynecological surgery prices we perform in our Istanbul Center In average gynecological procedures — price range is between TL.