It is a technique whereby a thin metal tube carrying a set of lenses and connected to a video camera is introduced into the abdomen through a  5 - 12 mm incision into the umbilicus under general anaesthesia. It is connected as well to a powerful light source which allows the inside of the pelvis to be seen clearly and in different magnifications. The laparoscope itself comes in different sizes but those used during operative procedures tend to have a wider diameter. However recent advances in optics physics allowed smaller scopes with brighter light transmission and clearer views of the pelvis to be used. Nevertheless most laparoscopic surgeons prefer to use a 10 mm  scope with 0^o angle for operative procedures.

Various operative techniques could be carried through additional 2— 3 small 5 mm incisions along the pubic hairline.

The merits of laparoscopic over open surgery are: 

• Small incisions are used during the procedure leading to:
  • good cosmetic effect
  • less postoperative pain
  • lower infection rate
  • usually patients go home on the same evening or the following day
  • quick recovery time due to minimal tissue damage and patients could go back to work within 7-10 days depending upon the nature of their jobs and the extent of the operation.

• The high magnification with bright light and recent advances in camera technology allow better exposure and easy reach to different areas with minimal tissue handling or damage.

• Excision of endometriotic lesions
• Removing ovarian cysts including endometriomas
• Excision of inflamed appendix
• Excision of adhesions which could be a cause of pelvic pain.
• Tubal surgery for sterilisation, infertility and ectopic pregnancies.
• Removing the uterus with or without the ovaries.
• Removing or reducing the size of fibroids. (Myomectomy and myolysis respectively).
• More specialised techniques for urological, oncological and pelvic floor repair.  

The most important issues to consider when discussing endoscopic surgery are related to patients safety. The list includes proper patients selection, proper surgeons training, a good supporting team and modern well kept equipment.

Patients should be made aware of the involved risks before cosenting to these procedures. The list includes perforation of bowel and blood vessels during the creation of pneumoperitoneum and introduction of the trocars, bleeding, infection, scar formation, need for laparotomy and failure of the procedure. Certain patients are more at risk than others to develop these problems including obese patients and those who had multiple abdominal or pelvic operations.

Continued on Laparoscopic anatomy