Laparoscopy
Laparoscopy in gynecology is a procedure in which the surgeon uses a laparoscope (an optical instrument) to visualize the pelvic and abdominal organs, as well as instruments that can be used not only to diagnose but also to treat various diseases.
Laparoscopy is an alternative to open surgery. A shorter recovery period, minimal pain, and improved aesthetic results are advantages that have made laparoscopy very popular among patients and surgeons.
Also, some technical parameters, such as excellent image quality during surgery and a relatively low risk of complications, have led to the widespread use of laparoscopic surgery in gynecology.
Laparoscopy diagram
How does the operation proceed?
At the beginning of the surgery, a special needle is inserted through a micro-puncture in the navel area, through which the abdominal cavity is filled with carbon dioxide. This is necessary to create a free space, allowing the surgeon to perform all procedures safely and precisely.
Next, the main micro-incisions are made. The first (only 5−10 mm long) is made in the navel area—this is where the abdominal wall is thinnest, and the scar is virtually invisible after healing. A laparoscope with a video camera and light source is inserted through this incision, transmitting images to a high-resolution monitor.
To use the instruments, the surgeon makes two to three additional 5-mm-long punctures. In gynecological practice, these are most often placed symmetrically along the lower abdominal line. The exact number and location of the incisions depends on the complexity of the case, the presence of adhesions, and the specific objectives of the surgery.
For diagnostic purposes, two additional instrument ports are usually sufficient. If surgical intervention is required, a third port can be installed, allowing the assistant to fully support the surgeon, ensuring maximum precision and safety.
Trocar placement
Progress of the operation and examination
After the optical port is inserted, the patient is placed in a head-down position (at a 15−30 degree tilt). This allows the abdominal organs to shift higher, allowing the surgeon easy and safe access to the reproductive system.
After all instruments are inserted, abdominal pressure is maintained at a constant level using a special high-precision device. This ensures a stable working space and patient safety throughout the procedure.
At the beginning of the procedure, a thorough panoramic examination is performed. A huge advantage of laparoscopy is the ability to peer into the most difficult-to-reach areas, often invisible even during open surgery. At this stage, the surgeon assesses the condition of the organs, establishes an accurate diagnosis, and determines the final treatment plan.
Normal endoscopic view of the pelvis
Safety, preparation and rehabilitation
The surgery is performed under general (endotracheal) anesthesia. This ensures complete muscle relaxation, ensuring the surgeon’s precision. Your breathing is supported by a modern ventilator under continuous monitoring by an anesthesiologist. Before the surgery, an anesthesiologist will conduct a consultation to determine the optimal anesthesia plan.
To ensure maximum safety, we consider all risk factors. The main limitations are:
- Anesthesiological: acute infections, severe heart or lung disease, blood clotting disorders;
- Surgical: late pregnancy, extremely large lesions, or very complex adhesions.
- Three days before surgery: switch to a light ("residue-free") diet;
- The day before: last meal before 11:00 PM;
- On the day of surgery: you can drink water until 6:00 AM;
- In certain cases (for example, with endometriosis), your doctor may prescribe additional bowel preparation.
- Movement: You can get up and walk within a few hours after the procedure;
- Discharge: Usually 1−3 days (determined by your doctor on an individual basis);
- Sutures: The incisions are sutured or sealed with glue. Sutures (if any) are removed after 7−10 days;
- Important: You may experience discomfort in the shoulders, collarbone, or neck. This is a normal reaction to the gas used during the surgery; the symptom resolves on its own within 2−3 days.
- Compression stockings: wear for 2−3 weeks;
- Sexual abstinence: 2 to 4 weeks (depending on the extent of the surgery);
- Physical activity: avoid for 1 to 2 months;
- Diet: limit foods that cause bloating for the first 2−3 days.
Today, approximately 95% of all gynecological surgeries are performed laparoscopically. This method is effective for treating infertility, removing cysts and fibroids, treating endometriosis, and correcting prolapsed organs. We also successfully use it in emergency cases, such as ectopic pregnancy.
Despite the advanced technology, there are situations in medicine that require conversion—a switch to open surgery. The likelihood of this scenario is low (only 6.3%) and depends on the complexity of the individual case. Your safety is our priority, so the surgeon makes the final decision on the approach method based on the clinical situation.
Robot-assisted surgery
One type of laparoscopy is robotic-assisted surgery. The da Vinci robotic system was first used in gynecology in 2005 in the United States for a hysterectomy. In Russia, the first robot-assisted surgery was performed in November 2007. Since then, robotic-assisted surgery has been widely used worldwide. As of 2020, there are approximately 5,500 da Vinci robotic systems in operation worldwide.
The da Vinci robotic system consists of three consoles: the surgeon’s console, where the surgeon, seated, controls the robot using joysticks and pedals; a robotic console that transmits images to the surgeon and mimics their movements; and a stand containing the equipment. It’s important to understand that the robot doesn’t perform the surgery itself, but rather mimics the surgeon’s movements with high precision.
DaVinci Si robot consoles
The advantages of robotic surgery are:
- 3D camera imaging system
This allows the surgeon to see images with a true depth effect; instruments have an increased range of motion; and, because the surgeon is seated at the console, the surgeon expends less energy, even during complex and lengthy procedures, as well as with significantly overweight patients. The surgical console features numerous adjustments for comfortable arm, leg, and head positioning, allowing the surgeon to perform complex procedures in a comfortable position.
2. The amount of blood loss decreases
(Compared to laparoscopic and open approaches with robotic surgery.) However, the costs of robotic-assisted surgery are higher compared to the aforementioned approaches. Therefore, not all gynecological surgeries should be performed robotically. It is advisable to use it in gynecological oncology, for the treatment of severe forms of endometriosis, pelvic organ prolapse, and multiple uterine fibroids, especially in overweight patients.
Features of robotic surgeries
Preparation for surgery and postoperative care are similar to those for conventional laparoscopy.
The points for installing trocars and inserting instruments during robot-assisted surgery differ from those during laparoscopy: the first optical trocar is usually installed above the navel (12 mm long incision), the remaining trocars (3 for robotic instruments and 1 for the assistant’s instrument) are on the right and left at the level of the navel (5−8 mm long incisions).
The removal of sutures from the anterior abdominal wall is also performed 7−10 days after the operation.
Comparison of robot trocars
As of 2026, Alexey Koval has performed more than 100 robot-assisted surgeries.
Other types of surgical care
A full range of high-tech surgeries to solve complex gynecological problems.
Hysteroscopy
A method for diagnosing diseases of the uterine cavity and cervical canal using an optical instrument (hysteroscope) with the possibility of simultaneous treatment under visual control.
Vaginal surgery
A non-incisional, vaginal approach. Effectively treats prolapsed organs, urinary incontinence, and pelvic floor aesthetic defects.
Laparotomy
A type of surgical approach in which the tissues of the anterior abdominal wall are dissected layer by layer to gain access to the organs of the abdominal cavity and pelvic cavity.