Minimally Invasive Surgery (MIS)  
  Gynaecological Surgery  
Many gynaecological conditions require abdominal surgery of which there are two types:

1. The traditional open method (laparotomy) in which a long abdominal incision is made.
2. Operative laparoscopy - also known as minimally invasive surgery (MIS). This is a new method which makes use of the laparoscope, a narrow fibre-optic telescope about as wide as a pen and small delicate instruments that are inserted into the abdomen for the operative procedures

The advantages of Operative Laparoscopy:

1. Small punctures instead of one long incision
2. Reduced post-operative pain
3. Shortened hospital stay
4. Shortened convalescence
5. Reduced risk of adhesions
6. Reduced risk of infection

To the patient the most significant improvement is the marked reduction in the size of the incisions. Small punctures of 5 or 10 mm, usually 3 to 4 in number, result in much less pain than the standard laparotomy incisions of 6 to 10 cm. Healing tends to be rapid resulting in early mobilisation, a shorter hospital stay and more importantly an early return to work. The cosmetic value is also important to many patients who do not wish to have long, obvious scars. Of greater importance are the benefits of reduced risk of infection and adhesion formation. Laparoscopic surgery is by nature a closed operation and hence reduces the risk of contamination. The moist conditions maintained in the abdomen also reduce the risk of adhesionformation, which can cause pain.

What are the common procedures?

1. Adhesiolysis
2. Treatment of ectopic pregnancy
3. Treatment of endometriosis
4. Ovarian cystectomy
5. Removal of ovaries/ tubes
6. Treatment of polycystic ovaries
7. Tubal ligation
8. Salpingostomy
9. Myomectomy
10. Infertility

What other procedures can be achieved with MIS?

Hysterectomies have been done with MIS. Other operations include the Birch colposuspension for stress incontinence, uterine suspension, tuboplasty and tubal reanastomosis, pelvic tumor surgery to name a few. With the operating hysteroscope, endometrial ablation for heavy menstruation, submucosal myomectomy and excision of endometrial polyps are well established.

How long does it take to do an operation with MIS?

With carefully chosen cases, it should not take more than two hours to complete a procedure. Sometimes, however, it may be necessary to proceed to laparotomy if complications arise. Every patient should bear this in mind.

What is the approximate length of inpatient stay?

Generally, the duration of inpatient stay is shorter after MIS although there is no hard and fast rule. Almost all patients need no catheterization as they can pass urine the same day. Most patients ambulate and can take feeds by the end of the day. An overnight stay or two is all that is required for most patients; however some may even be able to go back the same day.

• Consultation (first time) and physical check-up
• Ultrasound scan of uterus and ovaries
• Comprehensive Blood / Stool / Urine tests (35 items)
• PAP smear (cancer screening of cervix)
• Colposcopy of cervix

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