Among the most important innovations in today's modern medical era is the development of endoscopic surgical techniques. Laparoscopy is the application of endoscopic surgery in intra-abdominal operations. Thanks to the widespread use of laparoscopic surgery, especially in the last 20 years and the training of highly experienced surgeons applying this technique during this time, almost every operation can now be performed with this technique. While this technique was used for very limited and simple operations or only for diagnosis 15 years ago, today many difficult operations such as cancer surgery can also be performed.
When performed by experienced teams, 95% of surgeries in gynecological diseases can be done with the endoscopy technique. In endoscopic or minimally invasive surgery, operations are performed outside the body, and the image inside the abdomen is transferred to the monitor with a camera system. Endoscopic surgery in gynecological diseases is divided into two, laparoscopy and hysteroscopy. It is called laparoscopy when performed from the abdomen, and hysteroscopy in intrauterine operations when performed through the vagina.
How can laparoscopic surgery be performed?
Laparoscopic laser surgery is performed under general anesthesia. A 1 cm incision is made through the navel, and the abdominal cavity is inflated by giving 3 to 4 liters of carbon dioxide (CO2) gas with the help of a needle. Then, an optical tube (laparoscope) is inserted into the abdomen by entering through the navel.
This optical system is connected to a video camera system and the intraabdominal image is projected onto the monitor screen. In this way, the laparoscope can be directed to any area in the abdomen and viewed on the monitor. Then, two 0.5 cm holes are made in the groin areas. These holes are used to insert the instruments to be used in the operation.
Unlike conventional laparoscopy operations, in laparoscopic laser surgery, a laser system is attached to the tip of the laparoscope, apart from the camera. Thus, inside the laparoscope there is an optical channel and a second channel through which the laser beams will pass. With the laser energy controlled by the surgeon, procedures such as cutting, burning and stopping bleeding during the surgery can be performed in the abdominal organs.
The use of laser brings many advantages to laparoscopic surgery, and it also significantly shortens the operation time. The shortening of the operation time, on the other hand, provides that the patient receives less anesthesia and recovers faster. The laser device is mounted on the laparoscope, which is entered through the navel via the laser arm. The laser device produces laser beams released by atoms that are stimulated and activated by electrical energy. By means of the mirrors in the laser arm, the direction of the laser beams is changed and they are delivered to the desired organ or region. Various laser sources (CO2, Argon, Nd:YAG laser, etc.) are used in laparoscopic surgery. In our center, especially CO2 laser is used for this purpose. It has many advantages over other laser types.
Many operations can be performed both with the help of laser and with instruments inserted through two 0.5 cm holes in the groin area. The laser light allows the operation by using it like a knife in the abdomen. With this technique, simple operations such as tying tubes for birth control can be performed, as well as advanced operations such as removal of myoma and uterus can also be easily performed through these 3 holes.
This technique has many advantages over conventional open surgery. Therefore, open surgeries are gradually being replaced by laparoscopic or endoscopic techniques in all surgical branches.
Its advantages can be listed as follows:
- Operations are performed without making a large incision, that is, without opening the abdomen. There is no large surgical scar on the skin. All operations are performed through 3 small holes opened in the navel and in the groin area. It does not leave any traces on the skin that are aesthetically disturbing.
- Since laparoscopy operations are performed with micro-surgery principles, minimal damage occurs in the abdomen and operating areas, and recovery is easier and faster.
- After laparoscopy, operation-related adhesions develop less in the abdomen. Since more adhesions occur in open surgeries, laparoscopy should be recommended primarily to expectant mothers who are considering having a child. Sometimes, obstructions occur due to adhesions formed in the tubes after open surgery.
- Since the most difficult areas to visualize in the abdomen can be easily seen with the laparoscopy method, the possibility and success of treatment increases.
- Since the complaint of pain is less following laparoscopic surgeries, the quality of life of the patient is better. The need of using pain killer is not much.
- Hospital duration after laparoscopic surgeries is short. Most patients are usually discharged the same or the following day. Mobilization and returning to normal physical activities are faster and easier. The patient recovers earlier since the abdominal wall is not opened.
- The duration of returning back to work is only 1 week. This duration may be as long as 6 to 7 weeks after conventional operations.