Laparoscopy: Keyhole Surgery

by Dr Agilan Arjunan, Fertility Specialist, KL Fertility Centre (Malaysia)



“Best Things In Life Are Free” is a well known proverb and sometimes it may not be easy to grasp its meaning entirely.  Well, as a gynaecologist and fertility specialist, I do see many woman and couples and become part of their journey to fulfil their dreams.

I feel “The Best Things In Life Are Small” and the best part of it , it comes in 3D .

Majority of women in their lifetime would have undergone a surgery. Whether a minor or a major surgery, it is still a nightmare to go through it. By the age of 60 , 1 in every 3 women would have undergone a hysterectomy ( surgery to remove the womb) for various reasons.

Traditionally, gynaecological surgeries ( surgeries involving female’s reproductive organs) , are associated with big skin incisions, painful recovery and longer time to get back to norm. Longer recovery means loss of quality time  with family, personal or professional. For some, it means loss of income.

Gynaecological surgeries has evolved so much that the traditional phrase ‘big skin incisions, painful and slow recovery’   have now become  ‘small holes, nearly painless and out -of-hospital the next day’ .

It’s called Laparoscopic surgery or keyhole surgery. Do you know that laparoscopic surgery has been reported since 1930s’, but yet many women do not know about this ?

Laparoscopy  generally requires between 2-4 small ‘keyhole’ incision on the abdomen (tummy). Through these small holes, instruments such as a laparoscope ( thin telescope-like instrument), scissors and grasper are introduced to perform the surgery. Latest development is 3D Laparoscopic surgery, where the surgery is done with 3D screen.

Currently , most of the gynaecological surgeries can be done laparoscopically. Even some gynaecological cancer surgeries are done this way.

Commonly performed gynaecological laparoscopic surgeries are :

  1. Hysterectomy (removal of womb)
  2. Myomectomy ( removal of Fibroid from womb)
  3. Cystectomy ( removal of a cyst from ovary )
  4. Diagnostic laparoscopy ( surgery to find a diagnosis such as in pelvic pain or part of treatment of infertility)
  5. Tubal ligation (permanent sterilisation for female)
  6. Fertility-related surgeries ( surgeries that are needed to help a women to conceive) with or without IVF / ICSI
  7. Endometriosis surgery
  8. Surgery to correct prolapse of uterus / womb
  9. Cancer surgeries ( cancer of womb and cervix)

You may be wondering how laparoscopic surgery can achieve ‘small holes, nearly painless and out -of-hospital the next day’ ? You are not the only one asking this question and this is not the only question asked.

Below are some of the common questions asked by many :

1. How will my surgical wound looks like ?

Your abdomen / tummy will usually have between 2 to 4 small cuts. The cuts are normally no larger than 1cm, typically in between 0.5 to 1cm.  The wound normally heals very well and the scars not very visible in majority of cases.

2. Is there any way to do surgery with smaller scar on my tummy?

Fortunately for you, YES , there is a way. It’s called Single Incision Laparoscopic Surgery, where only ONE cut about 2cm is made at the umbilicus.  Once it heals, you don’t even see the scar as it is within your belly button. However, it is not suitable for all types of surgery .

3. How a surgery can be done through a small hole ? Are you kidding me?

I am not a magician.. I use thin, small instruments to do the surgery. The laparoscope helps me to see the internal organs in a magnified view which is projected on a TV screen. The latest technology is a 3D screen which improves the clarity of image. The surgery is performed by utilising very specialised laparoscopic instruments.

4. Why less pain in laparoscopy? 

In traditional surgery ( laparotomy) , big skin incisions are made in order to gain access to internal organs. On the contrary,in laparoscopy only tiny punctures are made. Thus, post surgical pain as a result of wound healing is more severe in traditional surgery than in laparoscopy. In the majority, mild pain relief is sufficient.

5. How early can I walk after the surgery?

On the same day if possible! Because there is less post surgical pain, you can already walk after you do not feel dizzy due to the effects of anaesthetic medications. The next day, you back on your feet and getting ready to go home.

6. “Out of hospital the next day” , is this possible ?

Definitely a big YES, but it depends on the type of surgery done. It is even possible to go home the next day after a major surgery such as hysterectomy. This can be achieved because of quicker return of bowel function and very little pain after surgery.  For certain type of surgery, the patient can go home on the same day after the surgery! Generally, 1 night stay after surgery can be expected.

7. How will I know if laparoscopy or conventional surgery is better for me?

Laparoscopy surgery can reduce the chances of adhesion (scar tissues inside abdomen) formation. In laparoscopy, only fine instruments are used to perform the surgery, whereas in traditional surgery, the surgeon places his / her whole hand inside the abdomen. Therefore, traditional surgery has a higher likelihood of adhesion formation. This is especially important if you want to conceive because adhesion in the area of Fallopian tubes and ovaries may lead to difficulties conceiving.

Method of surgery is also dependent on the underlying condition that are being treated. Most of gynaecological surgeries can be performed laparoscopically.

8. Is laparoscopy surgery safe?

Any surgery, however small it is, has its risks. In laparoscopy, the magnified vision helps the surgeon to see the internal organs better. This can lead to reduced bleeding. Moreover, infection risk can be reduced because the internal organs are not exposed to the room air. Expert use of the surgical tools may lead to a better surgical outcome. In short, the skill of the laparoscopic surgeon can determine the outcome of the surgery.

Quicker return of mobility also reduces the risk of deep vein thrombosis (DVT) , which is formation of blood clot in your blood vessels due to prolonged immobility.

I hope by now you have a better understanding about laparoscopic surgery. I hope you could appreciate the benefits that it offer you. God forbid , if you need a gynaecological surgery in future, ask your gynaecologist about laparoscopic surgery. Don’t get a big scar for no reason and don’t make me say “ I told you so..”.

Remember , “The Best Things In Life Are Small”

3 responses to “Laparoscopy: Keyhole Surgery”

  1. Dear Dr.Agillan my name is Ravichandran I am diabetic patient over 20 years due this my both legs never damaged and since then I have erectile dysfunction and no ejuucaltion I am 49 still single I am not married because of this problem I want to know will I able to produce a child with you treatment if decide to get married ? I would like to come for a consulate on my number 0149327498

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