Surgery Using Laparoscopy
A laparoscopy forms the cornerstone for the surgical evaluation of the pelvis of an infertile woman after a basic infertility investigation is completed. In some cases where endometriosis, pelvic inflammatory disease, or pelvic pain needs evaluation, it may be indicated earlier in the evaluation. The laparoscopic procedure is sometimes combined with a hysteroscopy when indicated.
Laparoscopy is performed under general anesthesia in a surgical center. A small needle is inserted into the abdominal cavity and C02 gas is introduced.
The laparoscope (a telescope with a strong light and camera) is introduced through the navel. A variety of instruments can be inserted into the pelvis, through other small incisions, to perform diagnostic and corrective surgery.
This procedure allows the physician to visualize the internal organs where reproduction occurs. In every case, he undertakes a meticulous surgical evaluation of the pelvis documenting his findings by video .
As part of the surgical evaluation the following are examined.
- Evaluation of the tubes and ovaries.
- Exclusion of endometriosis, both overt and subtle
- Identification of adhesions
- Inspection of the uterus and the exclusion of fibroids
- Inspection of the appendix, intestine, gall bladder, liver, and upper abdominal cavity
Operative Laparoscopy (Laser Laparoscopy)
Many pelvic disorders can be treated safely and even the most distorted pelvis can be reconstructed using operative laparoscopy, always performed at the time of the diagnostic procedure. In the new millennium, laparotomy is rarely indicated because of the associated pain, scaring, and patient discomfort.
The advantages of the laparoscopic approach are as follows :
- Laparoscopy involves small incisions with far less postoperative discomfort and a rapid recovery time
- Less adhesion formation
- Markedly reduced hospital stay. Many procedures are easily performed as an outpatient and are cost-effective.
Procedures routinely performed via operative laparoscopy include :
- Removal of scar tissue around the tubes and ovaries (salpingolysis and/or ovariolysis) and opening blocked tubes (tuboplasty).
- Removal of ovarian cysts and endometriomas with reconstruction of the ovary to a fully functional state.
- Removal of endometriosis including advanced stage three and four disease involving both
- bowel and the urinary system. This is often done employing a multidisciplinary approach with a bowel surgeon and a urologist in attendance.
- Removal of uterine fibroids (even those involving the uterine cavity) with uterine reconstruction to a fully functional state.
- Removal of ectopic pregnancies with conservation of the fallopian tube where indicated.
- Tubal reana
Hysteroscopy
Hysteroscopy is a procedure where a tubular scope is placed inside the uterus, usually with the patient under anesthesia. It is a valuable tool in the study of infertility, recurrent miscarriage, or abnormal uterine bleeding.
After cervical dilation, the uterus is expanded with fluid facilitating visualization of the uterine cavity and its lining. Abnormalities in the uterus, such as polyps, fibroids or adhesions, or a septum can be visualized and by the use of small instruments, corrective surgery can be performed at the same time as the diagnostic procedure.
Patients usually return to work the day after the procedure and find in-office treatment more cost effective, and convenient than a hospital visit.