Have there been advances in gynaecological surgical treatment?

The most significant development in recent years has been minimally invasive surgery. In the early 1970s, the laparoscope became popular as a means of evaluating the pelvic organs for investigation of symptoms such as pelvic pain and infertility. At that time research showed that the pre-operative presumed diagnosis proved to be incorrect in more than 50% of cases! Since that time, however, there have been other developments. Ultrasound (Q4.7), for example, increases our ability to evaluate the structure of the pelvic organs without surgery reducing to some degree the need for laparoscopy

Minimally invasive surgery has been a significant development although its exact place is still under evaluation. Some gynaecologists now specialise in this form of surgery. At one time a diagnosis of an ectopic pregnancy necessitated a laparotomy to remove the tube. The patient would remain in hospital for a week and would be off work for another five weeks. We have learned from minimally invasive surgery that hospitalisation can be reduced.

A thirty year old lady presented with a second ectopic pregnancy in her right Fallopian tube. Two years earlier she had an ectopic in the same tube. The ectopic had been removed and the tube conserved. She now wished to have the tube taken away. Through a mini-laparotomy incision (conventional surgery rather than minimally invasive) the tube was taken away. The patient went home on the second post-operative day. Two weeks later she was back at work and had recommenced swimming. It is unlikely that she would have done better with minimally invasive surgery.  

Pilots specialise in the type of plane they fly: a Concorde pilot would not be expected to fly a jumbo nor a jumbo pilot a Concorde. Similarly, the accelerating developments in gynaecology should lead to the conclusion that individual gynaecologists should confine their interests and work with others in a team to ensure that patients receive the best possible options and treatments.

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