Types of Surgeries:
(Laparoscopic Surgery, Laparoscope, Key Hole Surgery, Belly Button Surgery) is a surgery where the surgeon inserts a small telescope into the patient’s abdominal cavity through a small sheath that is most often inserted through the bellybutton. This is almost always done under general anesthesia. This type of surgery allows the surgeon to visualize the abdominal and pelvic organs and allows for many types of “Minimally Invasive Surgical” or “MIS” procedures. This includes hysterectomy, fibroid removal, pelvic pain management, cutting scar tissue, removing cysts of the ovary, tubal pregnancies, sterilization, appendectomy, gall bladder removal, bowel surgery and many more.
Here the surgeon is just “looking around” to see what is causing the problem (scar tissue or endometriosis). This is the general term used on consents to see what is occurring. If no disease is found (normal findings) then it is a diagnostic laparoscopy. Almost all of our surgeries are “diagnose and treat” laparoscopies. The exception to this is when the bowel may be involved with endometriosis and a general surgeon will be needed and in those cases where cancer is found and needs to completed by an oncologist (cancer surgeon). Be weary of the surgeon who is only looking and says they will treat you later!
This is a general term used for most laparoscopies where the plan is to do something at the time of surgery. For example: Remove fibroids, treat adhesions or endometriosis or remove the uterus.
Single Site Assist (SAL) Laparoscopy:
Dr. Kondrup has coined this term after a procedure that he has been perfecting to reduce scars during a laparoscopy. This procedure involves only one “real” incision in the belly button the size of his index finger or thumb. It brings together different techniques taught to him by surgeons in different countries around the world including Singapore and Korea. After making the bellybutton incision a needle with a plastic shaft is inserted right above the pubic hair in the bikini line (or close to it) to insert a pediatric grasper or attachable grasper (PSS, Ethicon) to assist with the single incision. This procedure is excellent for removing an ovary or ovaries especially if the patient is BRCA positive. Only certain patients are good candidates for this type of surgery.[insert picture][insert or link MISSurgery video I uploaded to you]
Most patients will go home within a few hours of the surgery and recovery is just a few days. Heavy lifting may be limited for a few weeks if a bigger laparoscopic incision has been made.
This type of surgery is broken down into three categories:
- Remove the uterus and leave the cervix – Laparoscopic Supracervical Hysterectomy (LSH or Subtotal Hysterectomy).
- Remove the uterus and the cervix (Total Laparoscopic Hysterectomy (TLH), Laparoscopic Assisted Vaginal Hysterectomy (LAVH, LATVH).
- Radical Hysterectomy (for cancer of the cervix) Usually performed by a surgeon trained in women’s cancer treatment.
- daVinci robotic assisted hysterectomy (any of the above types but with robotic assistance.
The type of hysterectomy you will have will depend on your specific needs and the surgeons’ training and experience. I tend to favor the Laparoscopic Supracervical Hysterectomy when appropriate because of the quick recovery and decreased risk of infection.