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.
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)
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