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Laparoscopy
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Laparoscopy and hysteroscopy are two procedures that completely examine a woman’s internal pelvic structures and can provide important information regarding infertility and common gynecologic disorders. They discover problems that cannot be detected by an external physical examination. Laparoscopy and hysteroscopy can be used for both diagnostic (looking only) and operative (looking and treating) purposes. 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. Most of the abnormalities detected during these diagnostic procedures can be corrected at the same time by performing operative laparoscopy or operative hysteroscopy, thus avoiding an extra surgery. |
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Diagnostic Laparoscopy |
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Some of the gynecological problems that can be diagnosed by laparoscopy include:
 Endometriosis
Uterine fibroids and other structural abnormalities
Ovarian cysts
Adhesions (scar tissue)
Ectopic pregnancy
Pain, history of past pelvic infection, or symptoms suggestive of pelvic disease are factors that may necessitate this evaluation procedure. Laparoscopy is sometimes recommended after completing an initial infertility evaluation on both partners.
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Procedure |
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Laparoscopy is usually performed on an outpatient basis under general anesthesia. The time just after the completion of menstruation is generally preferred to perform this procedure. After administering general anesthesia, carbon dioxide gas is injected into the abdomen through a needle inserted through the navel. The gas pushes the internal organs away from the abdominal wall, creating enough space for the laparoscope to be placed safely in the abdominal cavity and decreasing the risk of injury to surrounding organs such as the bowel, bladder, and blood vessels. The laparoscope (a fiber-optic telescope) is then inserted through an incision in the navel. Based upon physician experience or the patient’s prior surgical or medical history, alternate sites may occasionally be used for the insertion of the laparoscope.
Reproductive organs including the uterus, fallopian tubes, and ovaries can be seen through the inserted laparoscope. A small probe is usually inserted through another incision above the pubic region to clearly view the pelvic organs. A solution containing blue dye is often injected through the cervix, uterus, and fallopian tubes to determine if they are open. If no abnormalities are detected, the incisions are stitched close. If defects or abnormalities are detected, operative laparoscopy can follow diagnostic laparoscopy. |
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Operative Laparoscopy |
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Operative laparoscopy treats many disorders safely through the laparoscope at the same time that the diagnosis is made. Some procedures where operative laparoscopy is employed include:
Removing adhesions from around the fallopian tubes and ovaries
Opening blocked tubes
Removing ovarian cysts
Treating ectopic pregnancy
Removing or ablating endometriosis from the outside of the uterus, ovaries, or peritoneum
Removing fibroids on the uterus
Removing diseased ovaries
Assisting in the performance of hysterectomy |
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Procedure |
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During 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.
While lasers can be a significant help in certain surgeries, they are expensive and are not necessarily better or more effective than other surgical techniques used during operative laparoscopy. Many factors, including the physician’s experience, location of the problem, and availability of equipment, influence the choice of technique and instrumentation. |
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Risks of Laparoscopy |
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The risk of death as a result of laparoscopy is very small (around 3 in 100,000). One or two women out of every 100 may develop a complication, usually of minor consequence.
The risks associated with laparoscopy include:
Postoperative bladder infection
Skin irritation
Formation of adhesions
Occurrence of hematomas of the abdominal wall near the incisions
Pelvic or abdominal infections |
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Serious Complications |
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Serious complications of diagnostic and operative laparoscopy are rare. The major risks include:
Damage to the bowel, bladder, ureters, uterus, major blood vessels, or other organs, which may require additional surgery.
Injuries can occur during the insertion of various instruments through the abdominal wall or during operative treatment.
Allergic reactions, nerve damage, and anesthesia complications rarely occur.
Postoperative urinary retention is uncommon and venous thrombosis is rare. |
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Conditions Increasing the Risks |
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Certain conditions may increase the risk of serious complications. These include previous abdominal surgery, especially bowel surgery, and a history or presence of bowel/pelvic adhesions, severe endometriosis, pelvic infections, obesity, or excessive thinness. |
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Postoperative Care |
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The amount of discomfort following laparoscopy depends on the type and extent of procedures performed. Normal activities can usually be resumed within a few days. After laparoscopy, the navel area is usually tender and the abdomen may be bruised. Gas used to distend the abdomen may cause discomfort in the shoulders, chest, and abdomen, and anesthesia can cause nausea and dizziness.
Some potential serious complications requiring immediate medical attention include:
Significant abdominal pain
Worsening nausea and vomiting
A temperature of 101° F or higher
Significant bleeding from an incision |
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Comparing Operative Laparoscopy and Laparotomy |
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Both laparotomy and laparoscopy are widely used to perform many gynecologic operations.
In laparotomy, an incision (“bikini” or “up and down”) is made to open the abdomen. Patients generally need to remain in the hospital for several days following surgery and may return to work in two to six weeks, depending on the level of physical activity required. Following operative laparoscopy, patients are generally able to return home the day of surgery and recover more quickly, returning to full activities in three to seven days.
Some surgeries may be too risky to perform via laparoscopy. In some other surgeries, it is not clear that laparoscopy yields results as good as those by laparotomy. While considering a gynecologic operation, the doctor shall discuss the pros and cons of performing a laparotomy versus an operative laproscopy. |
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