25 April 2014
The thought of needing gynaecological surgery is a daunting experience for most women. Being given choice often helps patients feel more in control and speeds up their recovery following surgery which is of paramount importance when all patients want is to get back to ‘normal’ as soon as possible.
As surgeons continually strive to refine techniques and improve the experience for their patients, Mr Tim Duncan, consultant gynaecologist, answers some questions and explains the benefits of new and exciting advances for patients in our region.
What is keyhole surgery?
“Keyhole surgery, often referred to as laparoscopic surgery, is a technique whereby an operation is performed through small cuts using a camera and specialised instruments."
Which gynaecological problems can keyhole surgery be used to treat?
“Many conditions which cause common gynaecological symptoms such as pelvic pain, discomfort during sex, troublesome periods and infertility can all be very accurately assessed and often treated this way. In particular, endometriosis, scar tissue and damage from previous pelvic infections. Also, ovarian cysts (fluid filled swellings) can be removed using keyhole surgery."
Can a hysterecomy be performed via laparoscopic (keyhole) surgery?
“Yes, there have been some significant improvements to the techniques and types of surgery we can offer through the keyhole route. In particular, hysterectomy (removal of the womb) can be performed this way which offers huge advantages to patients. This form of surgery can be highly effective in the treatment of period problems when medication has not been effective, as well as for conditions such as endometriosis, pelvic inflammation and fibroids (enlargement of the uterus).
"Some cancers affecting women, such as endometrial (cancer of the womb) and cervical cancer, can also be treated in this way. In fact, keyhole hysterectomy has recently been approved by NICE (National Institute of Clinical Excellence)."
Keyhole surgery typically offers a quicker recover time compared to an ‘open’ operation. Is this the same for a keyhole hysterectomy?
“This is one of the major advantages this type of surgery has over conventional operations. The recovery time is much, much quicker. Patients often only need to stay in hospital for 24 hours before they are feeling comfortable enough to go home – previously four to five days was not uncommon. What is even more impressive is the rapid overall recovery from the operation, which can be as little as two weeks, after which women often feel well enough to return to work.
"This compares very favourably with a recovery time of three months if a hysterectomy is performed through a cut on the tummy. I find that women who run their own businesses, who work or have a hectic social diary really value the speedy return to health. Also, for women who live alone, have dependants or have loved ones who are frail, the fact they are back on their feet so quickly is of great benefit."
Why do women recover so much quicker after keyhole surgery?
“The main factor which affects the speed of a patient’s recovery after an operation is the size of cut needed on the tummy. The bigger the cut the more discomfort and the slower the recovery. Since keyhole surgery is performed through tiny cuts (0.5-1cm) much less pain and discomfort is caused which makes for a much quicker recovery. As less pain is experienced, women don’t require as much pain relief, which may cause side effects such as sickness, constipation and dizziness. Patients usually experience very little blood loss and are rarely anaemic (low iron stores) after surgery. This means they have more energy and feel better, all of which helps to enhance the recovery process."
Patients are often told that surgery is not possible if they are very overweight. Is this the same for keyhole surgery?
“Not entirely. We do know that being overweight carries many health risks and may increase the risk of surgical complications; however, all the advantages that I have mentioned today mean that this type of surgery may be possible in such patients. Clearly, assessments must be made on a patient-by-patient basis."
Gynaecological keyhole surgery sounds very impressive. So, why isn’t all gynaecological surgery performed this way?
“Whilst there are numerous advantages to this type of surgery it is not possible in every patient. If patients have severe scaring from previous surgery, or certain medical problems, this type of surgery may not be feasible. I always perform a thorough assessment of an individual patient before making a personalised plan of treatment to address their specific needs. This includes whether or not they would benefit from this, or indeed any other type of surgery."
As a final thought Tim adds, “Keyhole surgery and in particular keyhole hysterectomy represents a huge step forward in the quality of care we can offer women. I hope this article raises women’s awareness of this highly effective approach to the treatment of many common gynaecological conditions."
All surgery carries an element of risk and the content of this page is provided for general information only. It should not be treated as a substitute for the professional medical advice of your doctor or other healthcare professional.