The removal of reproductive and/or pelvic organs involves intricate surgical techniques, each chosen based on individual medical needs and health considerations. The right technique can significantly influence recovery and long-term outcomes, so it’s crucial to be informed about the available methods.
Modern gynaecological surgeries employ various techniques, each with its own benefits and considerations:
Open Surgery or Laparotomy Surgery (incision into the abdomen)
Description: This traditional surgical method involves a surgeon making a large incision in the lower part of the abdomen to diagnose and treat various conditions. The incision can be made horizontally across the abdomen (similar to a caesarean section) or vertically in an up-and-down direction, depending on the specific reason for the surgery. Vertical incisions are often chosen for procedures like cancer treatments, where other organs might be affected.
Advantages: Allows direct visualisation and access to internal organs; May be necessary for complex cases or when treating larger tumours.
Considerations: Potentially more post-operative pain; Longer recovery time compared to less invasive methods; Results in a larger scar.
Laparoscopic Surgery (keyhole or minimally invasive)
Laparoscopic surgery is a minimally invasive technique that uses small incisions and a camera (laparoscope) to guide the procedure. A special camera is passed through a small incision in the abdomen, while other instruments are inserted through separate small incisions (usually 2-3). Depending on the organs involved, they may be removed either completely or in small pieces (morcellated) through these incisions or via a different incision in the vagina.
Advantages: Shorter recovery time compared to traditional open surgery; Less post-operative pain; Smaller scars; Reduced risk of infection.
Considerations: May not be suitable for all cases, especially complex ones; Requires specialised surgical training.
Vaginal Surgery (Vaginal approach)
Vaginal surgery involves performing the procedure through an incision made in the vagina, allowing the surgeon to remove organs without making any external cuts in the abdomen.
Advantages: No visible scarring, as there are no external incisions; Often results in faster recovery; Particularly suitable for certain uterine conditions.
Considerations: May not be possible in cases involving adhesions or large fibroids; Limited to specific types of procedures.
Laparoscopic-Assisted Vaginal Surgery (LAVH)
Laparoscopic-Assisted Vaginal Surgery (LAVH) is a surgical technique that combines laparoscopic and vaginal approaches. Part of the operation is performed through keyhole incisions in the abdomen, while the other part is done through an incision in the vagina. This method leverages the benefits of both laparoscopic and vaginal techniques.
Advantages: Minimally invasive approach; Combines the benefits of laparoscopic precision with the advantages of vaginal surgery.
Considerations: May not be suitable for all patients or conditions; Requires expertise in both laparoscopic and vaginal surgery.
Robot-Assisted (Robotic) Laparoscopic Surgery
Robotic-assisted surgery is an advanced technique that utilises robotic arms controlled by the surgeon to perform the procedure. The robotic system provides 3D visualisation and enhanced precision, allowing for more precise movements and reducing hand tremors. This method enables surgeons to perform complex procedures minimally invasively, often through very small keyhole incisions in the abdomen.
Advantages: Enhanced precision during surgery; 3D visualisation for better depth perception; Reduced hand tremor, leading to more controlled movements; Often allows complex procedures to be performed with minimally invasive techniques.
Considerations: May have longer operating times compared to traditional methods; Requires specific, often expensive, equipment and specialised training.
Choice of Surgical Technique
The choice of surgical technique depends on various factors, including:
- The specific procedure being performed
- The size and location of the problem (e.g., fibroids, endometriosis)
- Your overall health and body type
- Previous surgeries you may have had
- Your surgeon’s expertise and preference
- Available hospital resources
It’s important to discuss the pros and cons of each applicable technique with your surgeon. They can provide insight into which method is most appropriate for your individual case, considering factors like recovery time, potential complications, and long-term outcomes.
References
Cleveland Clinic, Oophorectomy. [Updated 12 Sept 2022].
Cleveland Clinic, Hysterectomy. [Updated 31 May 2024].
Webmd, Oophorectomy. [Reviewed 2 March 2023].
[Updated: 9 Sept 2024]
Surgical Menopause New Zealand Trust 