Gynecologic Minimal Access Surgery (MAS)
Minimal Access Surgery (MAS) is also referred to as “minimally invasive surgery”, “laser surgery” or “laparoscopic surgery”. Essentially, it is surgery performed via small entry points – in the case of the abdomen, “keyhole” surgery of small incisions; in the case of via the vagina without skin incisions, “colposcopic” or “hysteroscopic” surgery.
By not using large cuts (known as “laparotomy”) and not exposing internal organs to air or excess handling, MAS allows faster recovery, reduced chance of adhesions and improved long term benefits. An instrument with a light source and camera is passed into the abdomen (laparoscopy) via a small incision or into the uterus via the cervix (hysteroscopy). For laparoscopic work, depending on the nature of the surgery and whether suturing is required, a few more small incisions are usually required.What types of gynecological surgeries can be done by MAS?
Almost all non-cancerous and some cancerous surgeries can be performed by MAS – cystectomy, myomectomy, hysterectomy, tubal/ectopic pregnancy, tubal repair, prolapse repair, appendicectomy, neurectomy, adhesiolysis, vaporization of endometriosis and hysteroscopic polypectomy, myomectomy, endometrial resection.
Are there limitations such as vision and access?
Visibility is better with MAS as the camera can reach all areas within the cavity. In the case of the abdomen, the surgeon will also usually check the status of the liver, gall bladder, etc, by swinging the camera around. This is not so in the case of a laparotomy where only what is exposed can be seen.
With due training and experience, the MAS surgeon can perform most of the modalities traditional laparotomy allows – including microscopic fine suturing and suturing around objects (use of robotics enhances these). Suturing and knotting techniques are well-developed.
Where is the place of Laparotomy?
The patient’s informed consent will include a discussion on the choice of approach – by MAS or by laparotomy. In some instances, laparotomy can give a better outcome.
For technical reasons or to secure the objective for surgery, it may be necessary to revert to a laparotomy in the course of any MAS. It is implicit that consent for a MAS approach includes consent for laparotomy. In addition, during surgery, other conditions not apparent previously may be found and further or alternative procedures or approaches may be needed.
How about recovery?
Please remember that although your recovery is fast and there is none or only a few small incisions, you have had major surgery and you must have adequate rest for about 1-3 weeks (2-6 weeks for laparotomy). Finish all antibiotics if given, but take the analgesics given only when necessary. The small incisions heal readily and minimal care is required.
Common post-operative complaints include shoulder pain, bloating, vaginal bleeding, sore throat and nausea. Relief will be given. Ask if you need something to aid sleep.
Possible complications include bleeding, urinary retention, infection, anaesthetic problems and damage to adjacent organs, such as ureter, bladder or bowel. Immediate or delayed further surgery may be required.
Being well-informed can help you to have a successful surgery, be more relaxed and have a good outcome. Before a surgery, if you have questions, always clarify fully with your doctor first.
Dr Alex Ooi is an Obstetrician and Gynecologist. He has served on the Mount Elizabeth Hospital Medical Advisory Board and was Chairman of the Minimal Access (“keyhole”) Surgery group, which revamped the operating theatres and initiated educational activities in Minimal Access Surgery. He has also been a Visiting Consultant to Fudan University in Shanghai and several other hospitals in the region.
|Dr Alex Ooi Koon Hean
MBBS (Singapore), MRCOG (UK), M Med (O&G)(Singapore), FAMS (O&G)
Specialty: Obstetrics & Gynaecology
Clinic: Alex Ooi & Associates OBGYN Consultants
Address: 3 Mt Elizabeth, #11-07, Mount Elizabeth Medical Centre, Singapore 228510Tel: +65 6738 8331
Fax: +65 6734 8896
Website: www.obgyndr.org and www.liposuction.com