Advancements in Gynaecological Surgery: How Minimally Invasive Techniques are Revolutionising Women’s Health & Fertility

The field of gynaecology has witnessed remarkable transformations, leading to significant improvements in women’s health and wellness. The latest issue of The POGS Chronicle, “Womb & Wellness,” highlights these sophisticate

d medical and technical advances, particularly in minimally invasive gynaecological surgery. These innovations are not only enhancing diagno

stic accuracy but also making treatments safer, faster, and more effective.

The Dawn of a New Era: Understanding Gynaecological Endoscopy

The desire to peer into the human body is as old as recorded history, with early descriptions of endoscopic 

examinations dating back to Hippocrates in Greece (460-375 BC), who referenced a rectal speculum. A three-bladed vaginal speculum, similar to modern instruments, was even found in Pompeii’s ruins from 70 AD. Fast forward to the 20th century, and pioneers like Raoul Palmer performed the first gynaecological laparoscopy in 1944, and Kurt Semm developed automatic insufflators in the 1960s, profoundly shaping the development of what he termed “Pelviscopy”.

Today, gynaecological endoscopy has blossomed into a fine art, combining science and skill. These sophisticated procedures, encompassing both laparoscopy (abdominal approach) and hysteroscopy (uterine cavity approach), offer significant advantages over traditional open abdominal surgery. Benefits include superb clear visualisation, reduced incidence of adhesions, minimal trauma, lower complication rates, rapid recovery, shorter hospital stays, and cosmetically better outcomes with less scarring.

Empowering Fertility: Key Endoscopic Surgeries for Conception

For many couples struggling with subfertility – defined as the failure to achieve clinical pregnancy after 12 months or more of regular unprotected intercourse – endoscopic surgeries offer hope by correcting structural or pathological causes.

Laparoscopic Fertility Enhancing Surgeries:

• Laparoscopic Myomectomy: Uterine fibroids, common benign tumours, can impair fertility by distorting the endometrial cavity or interfering with embryo transport. Laparoscopic myomectomy provides a minimally invasive alternative to laparotomy for removing various types of fibroids, leading to faster recovery and fewer postoperative adhesions.
• Laparoscopic Tubal Surgeries: Tubal disease or damage to the fallopian tubes accounts for 25-35% of infertility cases. Laparoscopic procedures like tubal cannulation for proximal blockages, salpingectomy for severe hydrosalpinx, or tubotubal reanastomosis for sterilisation reversal, aim to restore tubal patency and improve conception chances.
• Laparoscopic Adhesiolysis: Pelvic adhesions, often caused by inflammation or previous surgery, can distort anatomy and impede gamete and embryo transport. Laparoscopic adhesiolysis restores normal anatomy, improving pregnancy outcomes.
• Endometriosis Management: Endometriosis, a chronic inflammatory cond

  

  ition, affects up to 50% of infertile women. Laparoscopy is the gold standard for diagnosis and treatment, helping to manage adhesions and improve fertility.
• Laparoscopic Ovarian Drilling: For women with Polycystic Ovarian Syndrome (PCOS) who are resistant to ovulation induction drugs, laparoscopic ovarian drilling can induce ovulation and achieve high pregnancy rates by making the ovaries more receptive to lower-dose stimulation.

Hysteroscopic Fertility Enhancing Surgeries:

Uterine abnormalities contribute significantly to infertility, and hysteroscopy allows for precise interventions within the uterine cavity.

• Hysteroscopic Myomectomy: Submucous myomas (fibroids projecting into the uterine cavity) can be resected transcervically using operative hysteroscopy, improving pregnancy rates in infertile women.
• Hysteroscopic Tubal Cannulation: For proximal tubal blockages, hysteroscopic cannulation can restore patency and increase pregnancy rates, offering an alternative to IVF in some cases.
• Hysteroscopy for Metroplasty in Septate Uterus: A uterine septum, the most common congenital uterine anomaly, is associated with recurrent pregnancy loss. Hysteroscopic metroplasty significantly improves reproductive outcomes by incising the septum.
• Hysteroscopy for Intrauterine Adhesions (Asherman’s Syndrome): Adhesions within the uterine cavity, often caused by curettage, can impair reproduction. Hysteroscopic adhesiolysis is the main treatment, improving pregnancy and live birth rates.
• Hysteroscopic Polypectomy: Endometrial polyps, localised hyperplastic overgrowths, can be effectively resected hysteroscopically, improving fertility and pregnancy rates regardless of their size or number.

Beyond Fertility: Other Minimally Invasive Gynaecological Procedures

Minimally invasive techniques extend to a broad range of gynaecological conditions:

• Total Laparoscopic Hysterectomy (TLH): This procedure involves removing the uterus through small abdominal incisions, offering proven benefits over abdominal or vaginal hysterectomy, including quicker recovery.
• Laparoscopic Management of Adnexal Masses: Adnexal masses (growths near the uterus, ovaries, or fallopian tubes) can range from benign cysts to malignant tumours. Laparoscopy provides a safe and effective approach for diagnostic evaluation, removal of benign masses, and even staging in early-stage malignancies, offering reduced pain and shorter hospital stays. Special care is taken during specimen retrieval using endoscopic bags to prevent spillage and preserve oncological safety.
• Addressing Ectopic Pregnancies: Both tubal and scar pregnancies (implantation in a previous caesarean section scar) are life-threatening conditions. Minimally invasive surgical management, such as salpingostomy or salpingectomy for tubal pregnancies, or hysteroscopic/laparoscopic resection for scar pregnancies, is crucial for prompt treatment and maternal health.

The Technology Behind the Precision: Energy Sources in Endoscopy

The success of modern gynaecological endoscopy relies heavily on advanced energy sources for cutting, coagulation, and dissection.

• Electrosurgical Energy: This includes monopolar and bipolar systems. Bipolar energy is often preferred in hysteroscopy as it allows the use of normal saline, reducing systemic risks and providing effective cutting and coagulation with lower thermal injury. In laparoscopy, advanced bipolar systems like LigaSure offer superior vessel sealing with reduced thermal spread.
• Ultrasonic Energy: Devices like the Harmonic Scalpel use high-frequency ultrasonic vibrations to simultaneously cut and coagulate tissues at lower operating temperatures, leading to minimal lateral thermal spread, reduced smoke, and precise dissection.
• Hybrid Energy Systems: Newer devices, such as Thunderbeat, integrate both advanced bipolar and ultrasonically generated frictional heat energy into one instrument, further improving surgical efficiency and versatility.

These innovations are meticulously chosen by surgeons based on the specific procedure and desired outcome, ensuring optimal results while minimising complications.

POGS: Advancing Women’s Health Through Education & Innovation

Organisations like the Pune Obstetrics and Gynaecological Society (POGS) are at the forefront of these advancements. POGS demonstrates a strong commitment to education and engagement through cutting-edge webinars, masterclasses on medicolegal issues, and initiatives like Menstrual Hygiene Day.

Furthermore, POGS has launched a brand-new POGS App, available on Android and iOS, designed to centralise all POGS-related information. This state-of-the-art mobile application offers seamless new member and conference registration, monthly quizzes, and a digital library with newsletters, videos, and past lecture recordings, making it easier than ever to stay connected and engaged.

Conclusion

The evolution of gynaecological surgery, driven by minimally invasive techniques and advanced energy sources, has profoundly improved patient care, offering faster recovery, reduced discomfort, and enhanced fertility outcomes. POGS’s dedication to continuous learning and innovation, exemplified by their educational programmes and the new POGS App, ensures that healthcare professionals and patients alike can benefit from the latest advancements in womb and wellness.

Stay informed and prioritise your reproductive health. Always consult with a qualified gynaecologist to discuss the best treatment options for your specific needs.