Endoscopic Procedures

This is so-called key-hole surgery. It forms an integral part of all modern surgical disciplines and consists of diagnostic and therapeutic procedures conducted under guidance of a camera. The surgeon focuses on the image on the screen to conduct the procedure and does not come into direct contact with the target organ. There are three major types of gynaecological endoscopy: Laparoscopy, Hysteroscopy and Colposcopy.

Laparoscopy

This comprises the imaging of the abdominal and pelvic cavities through the umbilicus or belly button. A cavity is created by introducing Carbon Dioxide gas via a needle or directly through a laparoscopic port. In diagnostic procedures, the camera alone may suffice but for more complex operative procedures up to 3 additional ports may be sited. These ports vary in size from 5 to (rarely) 15mm. A wide variety of instruments can be used laparoscopically, from scissors, to cautery, to laser. Tissue can be removed via an endobag or by morcellation (where it is removed in strips). This is particularly useful for laparoscopic hysterectomy.

Recovery time from laparoscopy is extremely rapid, and therein lies the benefit of this approach. Most laparoscopies are day cases.

Hysteroscopy

In this procedure, a camera is introduced through the cervix or mouth of the womb. It images the uterine cavity and the openings of the Fallopian tubes. Small benign growths such as polyps and fibroids as well as developmental defects such as septa can be removed. This procedure is important in abnormal bleeding to take directed biopsies to exclude cancer.

Colposcopy

Generally an office procedure. A colposcopy is ordered where the routine PAP smear has found evidence of abnormality (see Routine Screening) The colposcope is essentially a microscope that is directed through the vaginal speculum. It magnifies the cervix and highlights areas of abnormal keratin deposition or other patterns associated with pre-cancer or cancer. It assists with directed biopsies or help to choose between an office procedure (such as cryotherapy or freezing the lesion) or surgical excision in theatre.


Dr Douglas Seton, Obestetrician & Gynaecologist Knysna © 2021

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