Laparoscopy is a surgical procedure in which a thin, lighted tube known as laparoscope is put through an incision in the belly to check the abdominal organs or female pelvic organs.
Why is Laparoscopy done?
Laparoscopy is done for:
It is conducted to check for conditions that make the natural conception for the woman difficult, which could be related to cysts, adhesions, fibroids or infection. In such cases, laparoscopy is done after initial infertility tests, which do not indicate the cause of infertility.
- Lap Myomectomy- Removal of fibroids
- Resection of Endometriosis
- Tubal Reconstruction is case of previous Laparoscopic Ligation also Known as Tubal Recanalisation.
- PCOD Drilling- for polycystic ovarian syndrome for patients who do not respond to medical management alone.
- Lap Adhesiolysis especially in cases of tuberculosis.
- Tubal Cannulation for Mucosal blocks in the tube.
Laparoscopy is a 30-90 minutes procedure and is usually done under a general anesthesia. A Small incision is made in the belly. Through this incision, a hollow needle is put, through which gas (carbon dioxide or nitrous oxide) is slowly released in the belly to inflate the belly, so the abdominal wall lifts away from the organs inside for a clearer view for the surgeon.
A thin, lighted tube known as the laparoscope is then put through the incision to look at the internal organs. Once the surgery is completed, the gas is released from the belly and the incisions are sutured and covered with a bandage. The scars are very small and fade away over time.
The patient is monitored in the recovery room for 2-4 hours. You may resume normal day-to-day activities from next day of the surgery. Strenuous activities & exercise should be avoided for at least 1 week.
Hysteroscopy procedure is done using a thin viewing tool known as hysteroscope to look at the lining of the uterus. The hysteroscope has a light and a camera attached to it, through which the doctor can see the uterus lining on the video screen.
The tip of the hysteroscope is inserted into the vagina and gently moved into the uterus through the cervix.
Why is it done?
A hysteroscopy is done in infertile women for:
- Hysteroscopic Myomectomy : Wherein fibroids present inside the cavity of the uterus are removed at the same setting with special instruments like Resectoscope or Hysteroscopic Morcellators.
- Hysteroscopic Polypectomy: Polyps are benign growths present inside the uterus which lead to infertility and irregular bleeding per vaginum. These growths are removed at the Hysteroscopy.
- Septal Resection: Uterine septum is the presence of an abnormal wall within the cavity of the uterus which is resected (removed) at the time of Hysteroscopy so that infertility or miscarriage is prevented.
- Hysteroscopic Adhesiolysis is for ashermans syndrome: Sometimes small bands of tissue (Synechiae) present inside the cavity of the uterus are separated with special Hysteroscopic scissors.
- Hysteroscopic Tubal Cannulation.
Hysteroscopy is a short day care procedure and is done using sedatives or anaesthesia. You will be asked to have an empty bladder before the test. The doctor will insert a lubricated tool, speculum into your vagina, which gently spreads apart the vaginal walls for the doctor to see inside the vagina and the cervix.
The hysteroscope will be placed at the entrance of the vagina and gently moved into the uterus through the cervix. The doctor will then put gas or liquid through the hysteroscope into the uterus for a clearer view of the uterus lining. Video screen may be used by the doctor.
After the Hysteroscopy procedure, you will be monitored in the recovery room for 1-4 hours. Most patients go home on the same day of the procedure and in very rare cases, you may be advised to stay at the facility overnight.
It is normal to have some vaginal bleeding for 1-2 days post hysteroscopy. You may experience slight dizziness, stomach sickness or mild belly pain. These are temporary and should go away in 24 hours.
In case of infertility, Laparoscopy is often performed along with Hysteroscopy as the indication may be.
Tubal reversal surgery:
The tubal reversal surgery is performed under general anesthesia. A hysteroscopy (placing a small camera through the cervix into the uterus) is often performed at the same time to evaluate the uterine cavity. The patient can usually go home that day or the next day.
During the hysteroscopy, we clear any pathology in the uterus, such as polyps or fibroid that impair the pregnancy success.
After the hysteroscopy we perform a mini laparotomy (an incision in the abdominal wall) to carefully examine and evaluate the fallopian tubes for successful reversal. The damaged portion of the tubes is removed and tubes are carefully reattached using microsurgical techniques helped by a magnified image with a microscope. Very small sutures are used to bring the ends of the tubes together, utilizing microsurgical techniques to prevent scar tissue that may impede the future function of the tubes. A dye is placed through the tubes to ensure that the tubes are unobstructed.
What are the risks and success of tubal reversal?
- Age is one of the major factors of a successful pregnancy, and if you are debating when to have the procedure, the younger an individual is, the better. We prefer to do tubal reversal in women aged less than 43 years.
- The longer (10 or more years) time has elapsed from the date of tubal ligation, the lower the success of reversal.
- Pregnancy rates tend to be highest in women who had a fallopian ring used in their tubal ligation compared to tubal cautery, which can sometimes damage a large segment of the tube.
- The length of the tube in the end of the procedure should be about 4 centimeters or longer for good function.
- The success rate for reversal is about 50-80%.
- The risk of ectopic pregnancy is about 5% (in ectopic pregnancy an embryo implants somewhere other than the uterus, such as in a fallopian tube).