laparoscopy

laparoscopy is a surgical procedure involving the use of a scope and small instruments to look into the abdomen for diagnostic or operative purposes. For diagnostic purpose for its invasive nature it should not be the first test in the couples’ diagnostic evaluation. In general, semen analysis, hysterosalpingogram, assessment of ovarian reserve and documentation of ovulation should be assessed prior to consideration of laparoscopy. For example, if the woman has a clear ovulation problem or her male partner has a severe sperm defect then it is unlikely that laparoscopy will provide additional useful information that will help them conceive.

There are many indications for having a laparoscopy performed.

  • Pelvic pain
  • Endometriosis
  • Pelvic adhesions
  • Ectopic pregnancy
  • Evaluate the uterus
  • Evaluate fallopian tubes
  • Search for an explanation of Infertility

The procedure is conducted under general or spinal anesthesia. An incision is made into /above or below the umbilicus. A needle is then inserted through this incision into the abdomen. CO2 gas is introduced into the abdomen to distend the abdominal cavity. The insufflating needle is then removed and a 10 mm trocar is inserted through the incision. The camera can now be introduced into the abdomen. Once the abdominal wall has been inspected a smaller (5 mm) trocar is usually inserted above the pubic bone. A manipulating instrument is then used to move the abdominal contents around for inspection. Tubal patency is evaluated by observing spillage of methylene blue dye through the fimbriated end of the tubes, which pushed through the cervix. Here spillage of dye through the fallopian tube is visualized.

Healthy ovary, uterus and fallopian tube

When necessary, additional trocars and instruments can be used to perform operative laparoscopy. Many operations can be performed laparascopically which minimizes the patients recovery time. Cystectomies, myomectomies, and lysis of adhesions are few examples of the many procedures.

Incisions are very small usually less than 1/2 inch in length which heal without difficulty. Patients are discharged after 24 hours. Some diagnostic cases can be done on out patient basis and discharged after a few hours. Most patients are able to resume full activities within 2-3 days after laparoscopy. Some patients may notice abdominal discomfort, and shoulder pain. The shoulder pain is a result of the gas in the abdomen and a referred sensation to the shoulder.

Complications:
Any complications may occur in any patient. Like complication for anesthesia, injury to surrounding structures, bleeding during operation or at postoperative period like that. But possibility is very rare and things can be managed immediately. Sometimes if we feel the procedure risky for the patient after evaluation by laparoscope then laparotomy is done after discussion. Complications associated with laparoscopy include the possibility of damage to other structures in the pelvis such as the bladder, ureter, bowel and blood vessels. Unexpected open surgery (larger incision) is always a possibility, but is very uncommon.
Any surgery can have an anesthesia-related complication or be associated with post-operative infection, such as a skin infection at an incision site.
Fortunately, all of these complications are very unusual when laparoscopy is expertly performed on healthy women

Results:

Many of the patients get pregnant spontaneously after laparoscopy and in other cases it may optimize the result of other treatments.