The laparoscopic approach in gynaecology

Since the mid-1960s laparoscopy has grown from simplistic beginnings to become one of the most commonly performed and most valuable of gynaecological procedures. The role of minimal access surgery (MAS) has expanded, particularly in gynaecological oncology and predominantly in the area of hysterectomy and lymphadenectomy. MAS is used by virtually every surgical specialist and is widely established throughout gynaecological surgery, particularly in gynaecological oncology. In general terms the most significant characteristic of the post-surgical period following MAS is the rapid and progressive recovery of the patient. Laparoscopic surgery should be performed under general anaesthesia with the patient intubated and fully relaxed. The regional anaesthesia provides a sympathetic block that constricts the bowel and reduces the lumen size, again facilitating its displacement into the upper abdomen. In many ways, the surgical treatment of endometriosis, whether undertaken using 'open' or 'closed' approaches, is more difficult than treating most gynaecological malignancies.