LAPAROSCOPY SURGERY
(Intra abdominal keyhole surgery)
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What is a Diagnostic Laparoscopy?
A diagnostic laparoscopy is a procedure in which the doctor uses a laparoscope to look at the organs and tissues in your abdomen to detect pathology. A laparoscope is a thin metal tube with a light and tiny camera. Laparoscopy literally means ‘to look inside the abdomen’. It is a surgical procedure sometimes referred to by patients as ‘key hole surgery’. The procedure involves placing a telescope-like instrument through a small, usually 0.5-1 cm incision (keyhole) in the abdomen after filling the abdominal cavity with carbon dioxide gas. The laparoscope is then attached to a high-resolution TV monitor so that the surgeon and their assistants can complete the procedure without the need of creating a large opening in the abdominal wall.
Laparoscopy is usually performed on an outpatient basis under General Anesthesia which means that the patient can go home a few hours after the surgery. In addition, recovery times are much shorter than when large abdominal incisions are performed.
What is the purpose of Diagnostic Laparoscopy?
One of the important uses of diagnostic laparoscopy is the investigation of female infertility. Diagnostic laparoscopy may be recommended to look at the outside of the uterus, fallopian tubes, ovaries, and internal pelvic area. Many infertile patients require laparoscopy for a complete evaluation. Generally, the test is performed after the basic infertility screening tests, although the presence of pain, history of past infection or an abnormal ultrasound may signal the need to perform diagnostic laparoscopy sooner in the evaluation. In some women the fallopian tubes are blocked. This can prevent sperm and egg from coming together, causing infertility. With laparoscopy, a simple test confirms this possibility. A colored fluid is injected through the uterus. If the tubes are open the fluid will flow out the ends of the tubes into the abdomen. The surgeon can see this through the laparoscope.
Laparoscopy also allows us to determine whether there are any defects such as scar tissue, adhesions, endometriosis, ovarian cysts, ectopic pregnancy, tubal disease, genital tuberculosis, fibroid tumors and other congenital abnormalities of the uterus. If any defects are found then they can often be corrected with operative laparoscopy which involves placing instruments through ports in the scope and through additional, narrow (5 mm) ports which are usually inserted at the top of the pubic hair line in the lower abdomen.
How do I prepare for Diagnostic Laparoscopy?
Eat a light meal, such as soup or salad, the night before the procedure do not eat or drink anything after midnight or the morning before the procedure. This will help to reduce complications.
You will need to shave your private parts prior to the procedure.
You need to be accompanied by your spouse or another relative to help you in your post-op recovery period.
What are the risks associated with Diagnostic Laparoscopy?
Complications after laparoscopic surgery are rare. The incidence is about 3 of every 1,000 women who have diagnostic laparoscopy. However, the risks may be greater for people who are obese, smoke cigarettes, or have additional health problems.
There may be some soreness near the incisions, especially when twisting or stretching the body.
Since a breathing tube is used for the anesthesia, some patients may have a mild sore throat.
Laparoscopy requires general anesthesia which carries certain risks. Modern general anesthesia, however, is safe and reactions are rare. You must be sure to tell the doctor if you have had a bad reaction to anesthesia in the past, or if a close family member has experienced such a reaction.
There may be discomfort in the abdomen, upper chest, shoulders, and neck area due to the carbon dioxide used to inflate the abdomen, but this disappears quickly.
The abdominal organs, intestines, or blood vessels may be damaged. The doctor may perform abdominal surgery to repair them at the time of the laparoscopy.
The lining of the abdominal wall may become inflamed.
Most people recover quickly and resume their normal activities without problems.
What is Operative Laparoscopy?
Many infertility disorders can be safely treated through the Laparoscope at the same sitting. If we perform surgical procedures through the Laparoscope, we call it as Operative Laparoscopy. It often requires more small cuts above the pubic hair line (usually two or three). It also requires a series of specialized instruments like graspers, biopsy forceps, scissors, coagulators, electrosurgical or laser instruments needle holders and suture materials which are inserted through these small cuts. With Operative Laparoscopy, there are no major incisions, and the abdomen is not opened. Because of this, the patient can frequently go home the same day after surgery. This greatly reduces the cost of the surgery, and allows you to return to work and to your normal activities sooner. The amount of pain involved is also much less.
What is the purpose of this Operative Laparoscopy?
Many of the problems that affect fertility can be treated through the laparoscope. One of the most common is scar tissue formation (adhesions) around the tubes, ovaries, or uterus, which can interfere with the woman's ability to become pregnant. The scar tissue may be the consequence of previous infection, endometriosis, or prior surgery. The scar tissue is cut and removed (adhesiolysis) through the laparoscope, freeing the pelvic organs.
Operative laparoscopy can also be used to treat Endometriosis. Endometriosis is a very common disease that affects women, and often causes pain, infertility, and scarring of the pelvis. Through the Operative Laparoscope, the Endometriosis can be destroyed (fulgurated) and scar tissue can be removed. Occasionally, large endometriotic cysts form in the ovary (endometriomas or chocolate cysts). These can also be treated through the Laparoscope.
Other procedures that can be accomplished by Laparoscopy
Ø Tubal reconstruction
Ø Treatment of poly cystic ovaries(PCO Drilling)
Ø Collect eggs for in vitro fertilization
Ø Removal of uterine fibroids (Myomectomy)
Ø Removal of diseased ovaries
Ø Female sterilization (tubal ligation)
Ø Pelvic abscesses
Ø locating and removing misplaced an intrauterine device (IUD)
Ø Treatment of Ectopic (tubal) pregnancies
Ø Hysterectomy
Ø Correction of genital prolapse
Ø Uterosacral nerve ablation
Ø Presacral Neurectomy
Ø GIFT Procedure
Ø Bladder neck surgery
What are the benefits of Laparoscopy?
Ø More accurate diagnosis. This minor surgical procedure may help the doctor make a more accurate diagnosis about the cause of infertility.
Ø Therapeutic benefit. The doctor may be able to treat the cause during the laparoscopy.
Ø Shorter recovery time. Your stay at the hospital and time needed to recover will be much shorter than with more extensive abdominal surgery.
Ø Cosmetic- No stitches. The incision required is very small. It does not even need a stitch. Scarring is very less.
Ø Cost effective – Though the initial cost may be higher –considering the time out of work because of shorter recovery it is more cost effective.
Ø Fewer post-operative complications. Most need little or no pain medicine.
Ø Reduced risk of adhesions.
Ø Reduce risk of infection.
