Laparoscopy is a procedure used in the diagnosis and management of problems in gynecology, including infertility. It is performed using an instrument called the laparoscope, which is a slender miniature telescope with a light source. It enables visual inspection of the pelvis and abdomen. Laparoscopy is a safe and simple day care procedure.
Laparoscopy is generally not the first line of investigation in infertility. A diagnostic laparoscopy is used for detection of abnormalities in any of the pelvic organs (uterus, tubes or ovaries). The examples of abnormalities include endometriosis, uterine fibroids and presence of adhesions in the pelvis. It can also be used to diagnose any unexplained pelvic pain. Other reasons for a diagnostic laparoscopy include
- Removal of an intrauterine contraceptive device that has entered the abdominal cavity from the uterus
- To assess patency of the fallopian tubes (whether the tubes are blocked or open)
Prior to the procedure, the woman is required to undertake some blood tests and urine tests to evaluate her health. Laparoscopy is performed under a short acting general anesthesia. The woman is appropriately positioned and the procedure is carried out under aseptic precautions.
A small nick is made on the abdomen, below the umbilicus, through which a special slender needle is inserted into the abdominal cavity. Carbon dioxide is passed through the needle in order to distend the abdomen and move away the bowels, for easy visualization of all the organs. The needle is removed and the laparoscope is introduced through the same incision. The uterus, tubes, ovaries and the pelvis are visualized through the laparoscope. The dye test is carried out with the laparoscope still in place. Distilled water, mixed with a few drops of a dye called methylene blue, is slowly instilled into the uterus through a hollow tube passed into the uterine cavity via the vagina and cervix. Passage of this blue colored fluid through the tubes and its subsequent spill from the outer ends into the pelvic cavity is visualized through the laparoscope. This confirms whether the tubes are open or not.
At the end of the procedure the carbon dioxide that has been instilled is made to escape from the abdomen by gently pressing the sides of the abdomen.
After the procedure
After laparoscopy, the patient is given antibiotics to prevent any infection, and analgesics to relieve pain. Oral intake is begun 2 to 4 hours later. The patient is allowed to leave 4 to 6 hours later. There may be pain in shoulders or a sensation of bloatedness due to some of the carbon dioxide in the abdomen. This settles within a day as the gas is slowly absorbed. Normal work may be resumed after a day’s rest.
Complications are rare in laparoscopy. Some of the complications include:
- Accidental entry into a blood vessel or bowel or any of the pelvic organs. Management will involve abdominal surgery i.e. opening of the abdomen and repairing the defect
- Entry of air into a blood vessel and thus into the blood circulation, termed as embolism. This is an emergency and will require intensive care
Operative procedures are performed by the introduction of accessory instruments into the abdominal cavity in a manner similar to the introduction of the laparoscope. These instruments hold, cut or burn tissues. The procedure is monitored on a screen by means of a video camera attached to the laparoscope. Some of the procedures that can be performed are:
- Removal of adhesions in the pelvis
- Removal of uterine masses in the uterus, tubes or ovaries
- Removal of an unruptured tubal pregnancy
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