Minimally Invasive Surgery (MIS)

What is laparoscopic surgery?

Laparoscopy is a type of surgical procedure that allows a surgeon to access the inside of the abdomen (tummy) and pelvis without having to make large incisions in the skin. This procedure is also known as keyhole surgery or minimally invasive surgery.

Large incisions can be avoided during laparoscopy because the surgeon uses an instrument called a laparoscope. This is a small tube that has a light source and a camera, which relays images of the inside of the abdomen or pelvis to a television monitor.

What are the advantages of laparoscopic surgery over open surgery?

• Small incisions

• Fewer complications (blood loss, infection, ileus, etc.)

• Reduced trauma to surrounding tissues

• Improved visualisation

  • Magnification. The surgeon can magnify images on demand, effectively providing visualization superior to viewing with the human eye.

  • Collaboration. Images are broadcast to large-screen monitors so the entire surgical team can see the operative process in real time.

• Better access to hard-to-reach areas

• Increased precision of microsurgical tools enables more precise treatment and prevention of injury to vital structures such as the bowel, bladder, ureter, nerves and blood vessels

• Less pain

• Shorter hospital stay (typically same-day outpatient)

• Faster recovery time

• Decreased risk of postoperative complications

What are the facts refuting the myths surrounding laparoscopic surgery?

• Gynaecological cancer can be treated safely and effectively by laparoscopy

• Prior or multiple abdominal surgeries do not preclude having laparoscopy

• Large fibroids, cysts or masses do not preclude having laparoscopy. These pathologies may be removed by cutting into smaller pieces, placing in a collapsible bag, and removing through a small incision.

• Severe adhesions (scar tissue) do not preclude having laparoscopy

• Severe multi-organ endometriosis does not preclude having laparoscopy

• Bleeding or complications during surgery can be effectively managed laparoscopically and typically do not require conversion to open surgery. The skill of the surgeon is paramount in recognition, prevention and management of complications. Laparoscopy itself is not a cause for increased complications.

• Overweight and underweight patients may be safely and effectively treated by laparoscopy

While the above-outlined scenarios do not necessarily preclude an open surgical approach, there are situations in which an open procedure is preferable. In cases necessitating an open surgery, Mr Alazzam aims always to use the smallest safe incision.

What gynaecological procedures does Mr Alazzam perform laparoscopically?

Mr Alazzam performs the vast majority of his surgical cases laparoscopically, either by traditional laparoscopy or robotic-assisted laparoscopy. As laparoscopy requires increased training, skill and experience over the traditional open surgery, it is important that you select a seasoned surgeon such as Mr Alazzam, who performs a high volume of advanced minimally invasive cases. He has been performing advanced minimally invasive surgery since 2004

Mr Alazzam offers fertility-sparing surgery for malignant conditions when it is appropriate. He also offers fertility enhancing surgery for benign conditions. These techniques require advanced surgical skills in order to make it possible for a woman to achieve pregnancy.

Mr Alazzam philosphy is always to minimise the removal of healthy tissues and organs. He works extensively with his patients in order to provide them with the best care.

What are some fertility-sparing surgery procedures that Mr Alazzam offers for cancer conditions?

• Ovarian Cancer can sometimes be treated by unilateral salpingo-oophorectomy (removing one ovary and fallopian tube), saving the contralateral ovary, fallopian tube, and uterus, and proceeding with cancer staging

• Cervical Cancer early cervical cancer can be treated safely by removing the cervix (lower portion of the uterus), performing radical trachelectomy (removal of the cervix and adjacent tissue) and pelvic lymphadenectomy (removal of pelvic lymph nodes), and preserving the main body of the uterus, ovaries and fallopian tubes

What are some fertility enhancing surgery procedures that Mr Alazzam offers for benign conditions?

• Endometriosis it is possible to treat extensive endometriosis while preserving the main body of the uterus, ovaries and fallopian tubes, thereby avoiding hysterectomy

• Uterine Fibroids can often be treated laparoscopically by performing a procedure called myomectomy, which is the removal of fibroids and reconstruction of the uterus, thereby avoiding hysterectomy

• Tubal microsurery & re-anastomsis it is a procedure which Mr Alazzam performs for women who had previous sterlisation and wish to retain natural fertility

• Uterine anomaly surgery it is a procedure where there is a congenital anomaly that affects the uterine capacity, the defect is usually excised which is follwed by uterine re construction.

What is a hysteroscopy?

Hysteroscopy is a form of minimally invasive surgery. The surgeon inserts a tiny telescope (hysteroscope) through the cervix (neck of the womb) into the uterus (womb). The hysteroscope allows the surgeon to visualise the inside of the uterine cavity on a video monitor. The uterine cavity is then inspected for any abnormality. The surgeon examines the shape of the uterus, the lining of the uterus and looks for any evidence of intrauterine pathology (fibroids or polyps). The surgeon also attempts to visualise the openings to the fallopian tubes (tubal ostia).

What are the hysteroscopic surgery procedures that Mr Alazzam offers ?

• Investigation of abnormal vaginal bleeding

• Removal of endometrial or cervical polyps

• Removal of fibroids

• Resection of uterine septum (hysteroscopic metroplasty)

• Removal of intrauterine adhesions (scarring) known as Ashermans Syndrome

• Cannulation (opening) of the fallopian tubes

• Removal of a lost IUCD (intrauterine contraceptive device)

• Endometrial ablation- destruction of the uterine lining, a treatment for irregular or heavy menstrual bleeding