Understanding Minimal Access Surgery

Understanding Minimal Access Surgery

“The patient is under anaesthesia when a small incision is made near the umbilicus and the laparoscope is inserted”

Minimal access means accessing the surgery site by giving a small incision and doing the surgery using special equipment called laparoscope and hysteroscope. The surgery can be seen on a screen and is performed using specially designed equipment.

Types Of Minimal Access Surgery (Gynaecology) Laparoscopy

This is a procedure that allows surgeons to look inside the abdomen, using a special scope called laparoscope, which is inserted through a small Incision at the umbilicus, using a light source for visualization and carbon dioxide gas for distension of the abdomen. The patient is under anaesthesia when a small incision is made near the umbilicus and the laparoscope is inserted, Also, small holes are made on the sides, for introducing the assisting instruments. Laparoscopy is widely used for:

  • Hysterectomy (removal of uterus)
  • Myomectomy (removal of tibroids)
  • Ovarian cyst/tumours
  • Endometriosis
  • Ectopic pregnancy
  • Adnexal mass/ hydrosalpinx
  • As part of evaluation for infertility
  • Tubal surgeries and many more


This procedure is carried out by looking inside the uterus using a scope called hysteroscope. Normal saline is used as a distension media for hysteroscopy and the light source is common for laparoscopy and hysteroscopy. Hysteroscopy is used in many medical conditions such as:

  • Abnormal uterine bleeding
  • Uterine polyp
  • Submucous tibroids
  • Tubal cannulations
  • Evaluation for infertility
  • Adhesiolysis

Robotic Surgery

This is a further advancement of minimally invasive surgery. Though the principles of surgery are the same, it uses different equipment. Robotic surgery is completely done by the surgeon, but the advantage of this procedure is finer movements and manoeuvring by the robot, which is not available in rigid laparoscopes.

The role of robotic surgery is limited in benign gynaecology but it’s very good in certain conditions where intra abdominal adhesions are suspected due to previous surgeries and endometnosis and also for gynae-oncology.

Advantages Of Minimal Access Surgery

  • Better visualization and assessment of anatomic structures as compared to open surgeries
  • Better surgical outcomes
  • Less bleeding
  • Faster recovery
  • Less pain
  • Shorter hospital stay
  • Less complications
  • Small scar, so cosmetic value
  • Reduced post operative adhesions
  • Early return to work

Disadvantages Of Minimal Access Surgery

  • Special equipment required to do surgery
  • Special training needed
  • Equipment is more expensive
  • Some procedures may take a longer time
  • Injury related to bowels and major vessels is slightly more, but can be avoided if expertise is available.

Contraindications For Laparoscopy
There are some conditions where this method of surgery cannot be used:

  • Cardiopulmonary compromise
  • Lung disease
  • Hemodynamically unstable patient
  • Third trimester of pregnancy

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