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Every day hundreds of women in Australia undergo surgery for treatment of pelvic disease. Until recently this involved open surgery (laparotomy) for the treatment of common problems such as urinary incontinence, endometriosis, ovarian cysts, pelvic floor prolapse, muscle growths within the uterus (fibroids) or for the removal of a uterus itself (hysterectomy). Today however, modern technology allows us to complete these same standard surgeries using far less invasive techniques, in particular, laparoscopic (keyhole) surgery.

What is Open Surgery?

Open surgery involves cutting a large 8cm to 10cm incision into the abdomen to expose the area of the body on which the operation is to be performed. Much of the postoperative pain is due to this large incision. As a result of this you often need to stay in hospital for five to seven days. In some cases you may also require up to six weeks of recovery before you are able to return to normal activities, such as, your usual occupation. In addition to the disruption to your family life and employment, open surgery also carries a bigger risk of adhesion and infections. This is due to the increased exposure of body tissue to the external environment that is necessary in open surgery.

Is there an alternative to Open Surgery?

Yes. The alternative is laparoscopic surgery or commonly referred to as keyhole surgery. Laparoscopic surgery or keyhole surgery eliminates the need for a large incision and is a safe and effective alternative to open surgery.

What happens in Keyhole Surgery?

Most keyhole surgeries involved only few half to one centimetre incisions. The first is made at the navel where a viewing telescope attached to a camera and light source (the laparoscope) is passed through a specially designed tube into the abdomen. This allows the surgeon to see the operative area on a video monitor. Two or three other small incisions are made to create passageways for other specially designed surgical instruments, which help the doctor to carry out the same types of procedures as in open surgery, the only difference being that surgeons refer to the video output to guide them through the surgery. No need for large incisions and painful procedures.

Conditions suitable for Keyhole Surgery:

The Benefits of Keyhole Surgery:

As the incisions are much smaller, pain can be significantly reduced with less need for postoperative pain medication. This has been shown in numerous studies both here at SWEC and internationally. Less pain means shorter hospital stays and a faster recovery. In many instances this means recovering in the comfort of your own home and being able to resume employment within a few weeks. In addition to the better cosmetic healing of smaller incisions, keyhole surgery also reduces the risk of adhesions and infection because tissue inside the abdomen is not directly exposed to the outside.

In summary the benefits of keyhole surgery are:

  • Less invasive than traditional methods
  • Less time in hospital
  • Less trauma
  • Less pain
  • Less recovery time, which means you can resume normal activities sooner.
  • Less scarring

What are the risks?

There are risks associated with any type of surgery. The risks associated with keyhole surgery are very uncommon but they do include:

  • Side effects due to anaesthesia such as nausea
  • Infection
  • Bleeding
  • Leg vein thrombosis
  • Injury to nearby organs such as bowel, bladder or urethra, requiring further surgery.
  • Complications related to laparoscopy such as damage to blood vessels, bowels, and port site hernia.
  • Conversion to open surgery in case of unexpected complication or finding; such as malignancy.

Comparison with Open Surgery:

Key hole surgery

Open Surgery

Incision

Few small 0.5 to 1 cm

Large 8- 10cm

Scar healing

Smaller scars mean faster more extensive healing

Larger scar heals slower

Risk of internal adhesions

Greatly reduced due to less incision

Moderate risk

Risk of infection

Greatly reduced due to less exposure to external environment

Moderate risk

Hospital stay

Approx 2 days

Approx 1 week

Overall healing time (Time off work)

2- 3 weeks

Approx 5 to 6 weeks

Need for pain medication

Reduced

Significant

What to expect

What happens before surgery?

Once you have been referred by your GP you will have a personal consultation with a SWEC physician. Here the doctor will explain the condition that affects you and the likely outcome of non-treatment and treatment alternatives. Where surgery is the solution, the indication, the risks and benefits of treatment and whether your condition is suitable for keyhole surgery will be discussed. The ideal time within which your surgery should take place will also be organized.

You should take the time to consider our recommendations and whether or not you want to ask for other expert opinions, before making your final decision to proceed.

Once you decide to undergo surgery you will need to sign the consent form for the recommended treatment and an admission paper for the hospital.

Keyhole surgery is normally performed under general anaesthesia, this means you will be asked not to eat or drink anything for six hours before surgery. On admission you will be seen by a member of our nursing staff and your anaesthetist to discuss any issues you may have and to prepare you for the operation.

Please inform your doctors of any allergy or past anaesthetic problems as early as possible.

What to expect following the operation?

Recovery following the operation depends upon the type of procedure you have undergone. Generally, you may experience some of the following symptoms which may last for a day or two:

  • Pain at the site of the incisions
  • Shoulder tip pain from the gas used
  • Abdominal bloating sensation
  • Mild nausea related to anaesthesia
  • Mild vaginal bleeding or discharge

Recovery at home:

Following your discharge from hospital, avoid strenuous exercises for about a week. Remove the bandages from the incisions the day after surgery. Apply an antiseptic solution and leave them exposed to dry. You will be advised if the sutures will dissolve on their own or if they need to be removed.

Vaginal bleeding will usually settle within a few days and you should use sanitary pads to control this rather than tampons to avoid infection. You may resume sexual activity as soon as it is comfortable for you, unless otherwise directed by your doctor.

Please notify your surgeon, your family doctor or the hospital you attended immediately if you have:

  • Severe or increasing pain
  • Fever
  • Nausea or vomiting
  • Persistent or heavy bleeding
  • Redness, swelling or discharge from the incisions