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Endoscopic (Keyhole) Surgery

endometrioma-s4-pa-after-blThis may be by Laparoscopy through the abdomen or by Hysteroscopy which is through the vagina and the opening of the neck of the womb into the cavity of the womb. The types of operations performed using the two types of approach are different.
Let us look at history of endoscopic surgery:

History of Endoscopic Surgery

n The history of laparoscopy dates back to 1901 when George Kerlling performed the first experimental laparoscopy and ever since laparoscopy has transformed from just a diagnostic procedure to an operative one.

n 1585, Aranzi was the first to use a light source for an endoscopic procedure, focusing sunlight through a flask of water and projecting the light into the nasal cavity

n 1706, The term “trocar,” was coined in 1706, and is thought to be derived from trochartor troise-quarts, a three-faced instrument consisting of a perforator enclosed in a metal cannula.

n 1806, Philip Bozzini, built an instrument that could be introduced in the human body to visualize the internal organs. He called this instrument "LICHTLEITER". Bozzini used an aluminium tube to visualize the genitourinary tract. The tube, illuminated by a wax candle, had fitted mirrors to reflect images.

n 1853, Antoine Jean Desormeaux, a French surgeon first introduced the 'Lichtleiter" of Bozzini to a patient. For many surgeons he is considered as the "Father of Endoscopy".

n 1867, Desormeaux, used an open tube to examine the genitourinary tract, combining alcohol and turpentine with a flame in order to generate a brighter, more condensable beam of light.

n 1868, Kussmaul performed the first esophagogastroscopy on a professional sword swallower, initiating efforts at instrumentation of the gastrointestinal tract. Mikulicz and Schindler, however, are credited with the advancement of gastroscopy

n 1869, Commander Pantaleoni used a modified cystoscope to cauterize a hemorrhagic uterine growth. Pantaleoni thus performed the first diagnostic and therapeutic hysteroscopy

n 1901, Dimitri Ott, a Petrograd gynecologist wore head mirrors to reflect light and augment visualization and used access technique in which a speculum was introduced through an incision in the prior fornix in a pregnant woman.

n 1938, Janos Veress of Hungary developed a specially designed spring-loaded needle. Interestingly, Veress did not promote the use of his Veress needle for laparoscopy purposes. He used veress needle for the induction of pneumothorax.

n 1944, Raoul Palmer, of Paris performed gynaecological examinations using laparoscopy and placing the patients in the Trendelenberg position, so air could fill the pelvis. He also stressed the importance of continuous intra-abdominal pressure monitoring during a laparoscopic procedure.

n 1960, Kurt Semm, a German gynaecologist, who invented the automatic insufflator. His experience with this new device was published in 1966. Although not recognized in his own land, on the other side of the Atlantic, both American physicians and instrument makers valued the Semm’s insufflator for its simple application, clinical value, and safety.

n 1960, British Gynaecologist Patrick Steptoe adapted the techniques of sterilization by two puncture technique.

n 1977, Kurt Semm first time demonstrated endoloop suturing technique in laparoscopic surgery.

n 1978, Hasson introduced an alternative method of trocar placement. He proposed a blunt mini-laparotomy which permits direct visualization of trocar entrance into the peritoneal cavity

n 1985, The first documented laparoscopic cholecystectomy was performed by Erich Mühe in Germany in 1985

n 1989, Harry Reich described first laparoscopic hysterectomy using bipolar dessication; later he demonstrated staples and finally sutures for laparoscopic hysterectomy

n 1994, A robotic arm was designed to hold the telescopewith the goal of improving safety and reducing the need of skilled camera operator.

n 1996, First live telecast of laparoscopic surgery performed remotely via the Internet. (Robotic Telesurgery).

endometrioma-s4-fk2-beforeWhat is laparoscopy?

This is a surgical procedure performed under general anaesthesia. It involves passing a fine telescope general through the umbilical (belly button) area to view the abdomen and the pelvic region.

There may be two to three tiny cut about one to two centimetres just below the belly button and by the bikini line.

Carbon dioxide gas is normally used to distend the abdomen before viewing the pelvis or abdomen and before the operative procedure commences.

Why laparoscopy?

This is performed to look closely at the womb, fallopian tubes, ovaries, check if the tubes are open (dye test) in infertility investigation, check for plausible causes of pelvic pain, to treat endometriosis, ovarian cysts, for some fibroids, and for hysterectomy in certain situation where the indication permits.

Procedures That Laparoscopy Could be Utilised in Gynaecology

  • Dye test to check the tubes are open
  • To treat Ectopic pregnancy
  • To remove diseased/damaged tube e.g. hydrosalpinx
  • Tubal surgery – reconstruction
  • Separation of Adhesions (Scar tissues)
  • Treatment of Ovarian Cyst ( Removal of Cyst)
  • Removal of diseased ovaries
  • Ovarian drilling for treatment of anovulation especially in PCOS patients trying for pregnancy
  • Myomectomy (removal of fibroid)
  • Excision of endometriotic nodules
  • Treatment of endometriosis
  • Colposuspension for stress incontinence
  • Removal of appendix
  • Hysterectomy

Information regarding the procedure will be offered to you following consultation or before surgery.

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