Gynecological laparoscopic surgery in Pokhara: four years' experience at Charak memorial hospital

Minimally invasive surgery (MIS) has transformed gynecological practice worldwide because of its advantages including reduced postoperative pain, shorter hospital stay, and faster recovery. However, evidence regarding the implementation and outcomes of gynecological laparoscopy in low- and middle-income countries remains limited. This study aimed to evaluate the feasibility, safety, and perioperative outcomes of gynecological laparoscopic surgeries performed in a resource-constrained tertiary care center in Nepal.

A retrospective descriptive study with limited comparative analysis was conducted at Charak Memorial Hospital, Pokhara, Nepal. Medical records of patients undergoing gynecological laparoscopic surgery between 2019 and 2023 were reviewed. Primary outcomes included conversion to laparotomy and perioperative complication rates. Secondary outcomes included operative time, intraoperative blood loss, and duration of hospital stay. Complications were classified according to the Clavien-Dindo classification system.

A total of 159 patients were planned for laparoscopic gynecological surgery during the study period. Among them, 153 procedures (96.2%) were completed laparoscopically, while 6 cases (3.8%) required conversion to laparotomy. The mean age of patients was 37.2 ± 12.1 years. Ovarian cystectomy was the most common procedure performed (62.1%), followed by total laparoscopic hysterectomy (26.8%). Histopathological examination of ovarian cystectomy specimens demonstrated predominantly benign lesions with no malignant pathology identified. Total laparoscopic hysterectomy had significantly longer operative time and greater intraoperative blood loss compared with other procedures (P < 0.001). Most patients (84.9%) were discharged within two days of surgery. The overall complication rate was 6.5%, with most complications classified as minor (Clavien-Dindo Grade I-II). Fever was the most common postoperative complication. One major complication involving pelvic vein thrombosis and one intraoperative urinary bladder injury were encountered.

Gynecological laparoscopic surgery can be performed safely and feasibly in a resource-constrained setting with acceptable conversion and complication rates. Despite challenges related to resource limitations and the learning curve associated with MIS implementation, favorable perioperative outcomes were achieved. Further prospective and comparative studies are required to strengthen the evidence for wider adoption of minimally invasive gynecological surgery in similar low-resource settings.