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Laparoscopy

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Laparoscopy

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Diagnostic laparoscopy may be recommended to look at the outside of the uterus, fallopian tubes, ovaries, and internal pelvic area. Diagnostic hysteroscopy is used to look inside the uterine cavity. If an abnormal condition is detected during the diagnostic procedure, operative laparoscopy or operative hysteroscopy can often be performed to correct it at the same time, avoiding the need for a second surgery. Both diagnostic and operative procedures should be performed by physicians with surgical expertise in these areas. The following information will help patients know what to expect before undergoing any of these procedures.

Diagnostic Laparoscopy

Laparoscopy can help physicians diagnose many gynecological problems including endometriosis, uterine fibroids and other structural abnormalities, ovarian cysts, adhesions (scar tissue), and ectopic pregnancy. If you have pain, history of past pelvic infection, or symptoms suggestive of pelvic disease, your physician may recommend this procedure as part of your evaluation. Laparoscopy is sometimes recommended after completing an initial infertility evaluation on both partners. It is usually performed soon after menstruation ends.

Laparoscopy is usually performed on an outpatient basis under general anesthesia. After the patient is under anesthesia, a needle is inserted through the navel and the abdomen is filled with carbon dioxide gas. The gas pushes the abdominal wall away from the internal organs so that the laparoscope can be placed safely into the abdominal cavity and decrease the risk of injury to surrounding organs such as the bowel, bladder and blood vessels. The laparoscope is then inserted through an incision in the navel. Occasionally, alternate sites may be used for the insertion of the laparoscope based upon physician experience or the patient’s prior surgical or medical history. While looking through the laparoscope, the physician can see the reproductive organs including the uterus, fallopian tubes, and ovaries

A small probe is usually inserted through another incision above the pubic region in order to move the pelvic organs into clear view (Figure 2). Additionally, a solution containing blue dye is often injected through the cervix, uterus, and fallopian tubes to determine if the tubes are open. If no abnormalities are noted at this time, one or two stitches close the incisions. If abnormalities are discovered, diagnostic laparoscopy can become operative laparoscopy.

OPERATIVE LAPAROSCOPY

During operative laparoscopy, many abdominal disorders can be treated safely through the laparoscope at the same time that the diagnosis is made. When performing operative laparoscopy, the physician inserts additional instruments such as probes, scissors, grasping instruments, biopsy forceps, electrosurgical or laser instruments, and suture materials through two or three additional incisions. Lasers, while a significant help in certain operations, are expensive and are not necessarily better or more effective than other surgical techniques used during operative laparoscopy. The choice of technique and instruments depends on many factors including the physician’s experience, location of the problem, and availability of equipment. Some problems that can be corrected with operative laparoscopy include removing adhesions (scar tissue)from around the fallopian tubes and ovaries, opening blocked tubes, removing ovarian cysts, and treating ectopic pregnancy. Endometriosis can also be removed or ablated from the outside of the uterus, ovaries or peritoneum. Under certain circumstances, fibroids on the uterus can also be removed. Operative laparoscopy can also be used to remove diseased ovaries and can be performed as part of a hysterectomy.

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