Endoscopic Procedures
Endoscopic procedures are often referred to as “keyhole surgery.” They form an essential part of modern gynaecology and allow both diagnosis and treatment using a small camera for guidance. Rather than making large incisions, the surgeon works by viewing a magnified image on a screen, which allows for precision while minimising disruption to surrounding tissue.
There are three main types of gynaecological endoscopy: Laparoscopy, Hysteroscopy and Colposcopy.
Laparoscopy
Laparoscopy allows us to examine and treat conditions within the abdominal and pelvic cavities through the umbilicus (belly button).
A small working space is created by gently introducing carbon dioxide gas into the abdomen, either via a needle or directly through a laparoscopic port. In diagnostic procedures, a camera alone may be sufficient. For more complex operations, up to three additional small ports may be placed. These ports typically range from 5 mm to, in rare cases, 15 mm in size.
A wide range of instruments can be used during laparoscopy, including scissors, cautery devices and laser instruments. Tissue can be removed safely using an endobag or by morcellation, where it is removed in small strips. This technique is particularly useful in procedures such as laparoscopic hysterectomy.
One of the major benefits of laparoscopy is the rapid recovery time. Most laparoscopic procedures are performed as day cases, allowing patients to return home the same day.
Hysteroscopy
Hysteroscopy involves introducing a small camera through the cervix (the mouth of the womb) to view the inside of the uterus.
This allows direct visualisation of the uterine cavity and the openings of the Fallopian tubes. Small benign growths such as polyps and fibroids can be removed during the procedure. Developmental abnormalities, such as a uterine septum, can also be corrected.
Hysteroscopy plays an important role in the investigation of abnormal uterine bleeding. It allows for targeted biopsies to exclude more serious conditions, including cancer.
Colposcopy
Colposcopy is usually performed as an office procedure. It is recommended when a routine Pap smear has shown abnormal results.
The colposcope is essentially a specialised microscope used alongside a vaginal speculum. It provides a magnified view of the cervix and helps identify areas that may show abnormal cell changes. These may include patterns associated with pre-cancerous or cancerous changes.
Colposcopy assists in guiding precise biopsies and helps determine the most appropriate treatment. In some cases, an office-based procedure such as cryotherapy (freezing the affected area) may be sufficient. In others, surgical excision in theatre may be recommended.