Minimal access surgery (MAS) is not a subspecialty. It is a surgical approach or technique that can be applied to all of the recognised surgical subspecialties in gynaecology – urogynaecology, reproductive medicine, gynaecological oncology, as well as most, if not all, of benign gynaecological surgery. For an increasing number of surgeons, MAS is the firstline and predominant technique used for the majority of pelvic surgical procedures. It is done through laparoscopy (a scope for the abdomen) and hysteroscopy (a scope for the womb), which have many advantages, including less cost, a shorter hospital stay, a quicker recovery period, less risk of complications.
Laparoscopic surgery is an outpatient surgery, it is a minimally invasive surgery typically performed on the abdomen or pelvis with the assistance of a laparoscope (small video camera) which provides visuals for areas outside of the uterus such as fallopian tube, ovaries and the general pelvic region. Laparoscopic surgeries have very small incisions which lead to faster recovery times and less scarring. The procedure is performed under general anesthesia. This type of surgery is used to both diagnose conditions and to perform infertility treatments. Laparoscopy may be done after initial infertility tests which did not show the cause for the infertility. Laparoscopic surgery is used to remedy a variety of conditions that can make it hard for a woman to become pregnant including :
This is a condition where the tissues lining the uterus start growing outside of the uterus on the ovaries, bowel, bladder and other areas of the pelvic region. This can cause physical discomfort, irregular bleeding and infertility. Endometriosis is typically diagnosed in women between the ages of 25 to 35. Laparoscopic surgery can be performed to help remove the tissues causing infertility.
Adhesions are scar-like fibrous bands that form between tissues and organs causing two parts of your body to bind together that should be separate. Usually adhesions are painless, however they can cause infertility when formed between ovaries, fallopian tubes, the uterus or pelvic walls. Adhesions can typically be removed through laparoscopic surgery.
A common occurrence, fibroids are non-cancerous tumors in the muscle cells of the uterus. Most fibroids are very small and don't have any symptoms, but they can cause infertility if they block eggs or sperm from the fallopian tubes. Fibroids in the uterus can also make it harder for an embryo to develop. A laparoscopic myomectomy can remove fibroids.
Infertility can be caused by blocked fallopian tubes. The fallopian tubes may be blocked due to a number of reasons including scars from a pelvic infection, endometriosis, ectopic pregnancy, adhesions and more. Laparoscopic surgery can help unblock the fallopian tubes if necessary.
Ovarian cysts are small fluid-filled sacs that develop in a woman's ovaries. Most cysts are harmless, but some may cause problems such as rupturing, bleeding, or pain; and surgery may be required to remove the cyst(s). It is important to understand the function of the ovaries and how these cysts may form. Ovarian cysts affect women of all ages. The vast majority of ovarian cysts are considered functional. Most ovarian cysts are benign, meaning they are not cancerous, and many disappear on their own in a matter of weeks without treatment. Laparoscopy is done also to:
- Check for and possibly take out abnormal growths (such as tumors) in the abdomen or pelvis.
- Check for and treat conditions such as ectopic pregnancy, or pelvic inflammatory disease (PID).
- Find the cause of sudden or ongoing pelvic pain.
- Perform a biopsy.
- Perform a tubal ligation.
- Remove the uterus (Laparoscopic1 hysterectomy). This technique is an alternative technique to the abdominal hysterectomy.
- Remove the ovaries (Laparoscopic ovariectomy)
- Perform ovarian drilling during laparoscopy, in this1 procedure a laser fibre or electrosurgical needle punctures the ovary 4 to 10 times.
This treatment results in a dramatic lowering of male hormones within days and is often performed in women who have polycystic ovary syndrome (PCOS).
Hysteroscopic surgery involves the use of a small video camera to examine the uterus and uterine lining. The telescope goes through the cervix and into the uterus in order to view the uterine cavity. Hysteroscopic surgery is minimally invasive, using small incisions which provides less scarring, fewer complications and faster recovery.
A hysteroscopy may be done to see if a problem in the uterus is preventing from becoming pregnant (infertility). A hysteroscopy can be used to remove growths in the uterus, such as fibroids or polyps. It also may be done to find the cause of abnormal bleeding or bleeding that occurs after a woman has passed menopause.
The doctor may take a small sample of tissue (biopsy). The sample is looked at under a microscope for problems. A laparoscopy may also be done at the same time as a hysteroscopy if infertility is a problem.
A hysteroscopy may be done to:
- See whether a problem in the shape or size of the uterus or if scar tissue in the uterus is the cause of infertility.
- Find and remove small fibroids or polyps.
- Look at the uterine openings to the fallopian tubes. If the tubes are blocked, the doctor may be able to open the tubes with special tools passed through the hysteroscope.
- Find the cause of severe cramping or abnormal bleeding. The doctor can pass heated tools through the hysteroscope to stop the bleeding
- Find the possible cause of repeated miscarriages. Other tests may also be done.
- Use heated tools to remove problem areas in the lining of the uterus (endometrial ablation).
- Check for endometrial hyperplasia
- Place a contraceptive implant into the opening of the fallopian tubes as a method of permanent sterilization
- Find and reposition a misplaced intrauterine device (IUD).