Laparoscopic surgery is often called “keyhole” surgery.  This is because it is performed through tiny incisions in the abdomen, usually of 5-10 mm length.  The laparoscope is a surgical instrument similar to a telescope, usually placed through a small 0.5 cm incision at the umbilicus.  The other incisions are usually low down at the bikini line and are for entry of fine instruments into the abdomen to perform laparoscopic surgery.  The laparoscope is attached to a video camera and the surgeon works off a monitor screen which gives magnification, thus allowing surgical precision. 

Advantages:

• Surgical precision through magnification.
• Much quicker recovery than conventional open surgery
• Less time spent in hospital
• Reduced use of pain killers and medications
• Faster return to work
• Economic benefits to the patient, their work, the health care system and the economy.
• Smaller incisions so more “cosmetic”.
• Day case surgery.
• Can try for pregnancy much sooner than open surgery or medical therapy.

Advanced Laparoscopic Surgery

With an appropriate level of expertise, almost any intra-abdominal pelvic procedure can be performed laparoscopically.  There is now a world-wide trend towards more advanced laparoscopic surgery for severe endometriosis as well as other procedures that were done previously by open surgery (laparotomy).  Most hysterectomies can now be done by laparoscopy as can laparoscopic myomectomy (fibroid removal).  This skilled surgery requires extensive training, expertise and ongoing practice.  Dr Marshall has performed complex laparoscopic surgery for over 20 years and still operates regularly, 3-4 sessions per week. 

Surgical Methods

Different methods and energy sources can be used in laparoscopic surgery, and in particular for treatment of endometriosis and adhesions.  These include diathermy (burning), laser (vapourisation/ excision), cutting with scissors (excision), high frequency oscillation (harmonic scalpel) and others.  They all have their pros and cons but the important principles of treatment of any condition such as endometriosis are

• Complete removal/ excision of the pathology
• Safety (avoidance of complications)
• Limiting spread of thermal damage = precision
• Bloodless technique/ haemostasis
• Reduction of post operative scar tissue/ adhesions
• Encouraging faster and better healing

Dr Marshall uses all surgical methods but for most of his laparoscopic surgery he prefers to use the carbon dioxide laser as this is a very precise and safe instrument and results in a much clearer and complete removal of disease.  Laser laparoscopy surgery is also virtually bloodless and is certainly cleaner than ordinary diathermy.  There is less subsequent formation of adhesions after surgery.  However laser laparoscopic surgery requires appropriate training and expertise and should only be performed by people competent in the technique.

Risks

There are risks with all surgery but with laparoscopic surgery complications are much less common than with open surgery.  Complication rates are particularly related to the experience of the surgeon and Dr Marshall’s safety record is excellent.  However the following complications can occur with laparoscopic surgery:

• Infection – wounds, urine, pelvic
• Damage to organs such as bowel, bladder ureter or blood vessels
• Bleeding or haemorrhage