Types of gynaecological surgery
The abdominal approach was the most popular approach for early gynaecological surgery and is still used in many cases. It is performed by making an incision in the abdominal wall by planes, that is, layer by layer, until reaching the abdominal cavity.
A Pfannenstiel incision is usually made (traverse incision about 2 cm above the mons pubis) which has a more aesthetic outcome but may produce a slight increase in pain, tingling and seromas.
Another type of incision is infraumbilical midline incision, used in most oncology surgeries and special cases, which is a longitudinal incision that is less aesthetic but also causes less pain and seromas.
This is a commonly used approach because it is more natural for many types of gynaecological surgery. It is a more difficult approach anatomically and surgically but is less painful and postoperative recovery is easier for the patient.
It is still used in many cases of prolapse and incontinence surgery.
Laparoscopic surgery is a minimally invasive technique that makes it possible to see the abdominal cavity using a laparoscope. The laparoscope is a rigid tube with a small video camera and light at the end, which is inserted through a small 1 cm incision in the navel. The abdominal cavity must be inflated with gas (carbon dioxide) before inserting the laparoscope. To perform the surgery, two or three incisions are made in the abdomen through which surgical instruments (forceps, scissors, coagulation, etc.) are introduced.
This technique is performed under general anaesthesia, but speed and easier recovery make it sometimes possible to perform the surgery on an outpatient basis, the advantages of smaller incisions, sequels, postoperative pain and convalescence.
The most common indications are:
- Treatment of ovarian disease. cyst-oophorectomy
- Treatment of uterine disease: myomectomy
- Treatment of endometriosis and abdominal pain
- Treatment of ectopic pregnancy
- Hysterectomies
- Tubal ligations
- Urinary incontinence and pelvic floor disorders
- Cancer surgery: ovarian, uterine and cervical
This is a useful gynaecological procedure.
It involves inserting a small optical lens with a camera on the end into the vagina to see the internal cavity of the uterus and cervix. Surgical instruments are introduced through the surgical hysteroscope, which has diameter of 9 mm, and a liquid medium (serum) is used to separate the walls of the uterus.
This is an outpatient procedure that uses twilight anaesthesia and patients can go home a few hours after surgery.
The most common indications are:
- Removal of endometrial polyps
- Removal of submucosal fibroids
- Ablation/endometrial reduction (cauterise or extract the lining of the uterus)
- Resection of uterine septa
- Resection of uterine synechiae
- Permanent sterilisation (by tubal obstruction)