Laparoscopy/ Hysteroscopy

Laparoscopy is a surgical procedure that involves insertion of a narrow telescope-like instrument
through a small incision in the belly button (navel). The laparoscope is about as big around as a fountain pen and twice as long. This allows visualization of the abdominal and pelvic organs including the area of the uterus, fallopian tubes and ovaries.


What is laparoscopy used for in women with infertility?

This procedure allows us to determine whether there are any defects such as scar tissue, endometriosis, fibroid tumors and other abnormalities of the uterus, fallopian tubes and ovaries.

If any defects are found then they can sometimes 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.

Should I get laparoscopy done or other tests like tube test (HSG) first?

Because of the cost and invasive nature of laparoscopy 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.

Is Laparoscopy a big procedure? How much work would I miss?

Laparoscopy is usually done with general anesthesia (you go to sleep). The procedure usually takes between 20 minutes to 2 hours depending upon how much operative corrective work is required. A complicated case could take up to 4 hours or more.

The woman is generally discharged home from the hospital, in most cases the day after the surgery. Sometimes women may also go home the same day in the evening. You may need to take off an additional 1-2 days from work following the procedure.
Mild pain can be expected to last for a couple of days or so after the procedure.

What are the complications of laparoscopy?

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.


What is Hysteroscopy ?

Hysteroscopy is a surgical procedure in which a small telescope (the size of a pencil) is used to inspect the inside of the uterus. A camera is attached to the end of the telescope and the image is viewed on a video monitor. Surgery is carried out while looking at this 
monitor.

When is Hysteroscopy required to be done?

Hysteroscopy may be recommended for evaluation of
  1. Infertility
  2. abnormal uterine bleeding
  3. absent/ scant menses
  4. recurrent pregnancy loss
  5. abnormal findings on a hysterosalpingogram, ultrasound, or pelvic exam
  6. uterine fibroids
  7. polyps
  8. septums [divisions]
  9. the cavity of the uterus before ET in an IVF/ ICSI cycle.
  10. Intrauterine adhesions
  11. Cornual block
How is Hysteroscopy done?

The first step involves dilating the mouth of the uterus (cervix). The cervical opening must be enlarged to allow passage of the hysteroscope. Once inside the uterus, gas or fluid is used to distend the cavity. The Doctor then inspects the uterine walls, openings of the fallopian tube, and overall architecture of the womb.

What is Diagnostic Hysteroscopy?

Diagnostic hysteroscopy can be performed with a smaller instrument. This procedure is generally shorter and can be done under mild sedation or short general anaesthesia for better comfort The procedure is quick and inexpensive.

What is Operative Hysteroscopy?

Operative hysteroscopy is performed under general anaesthesia. This allows the physician to both diagnose and treat most findings, which are encountered at the time of the procedure.

The Operative Hysteroscope has ports, which allow the physician to insert operating tools, such as, scissors, cautery devices or a laser fiber. These may be used to resect or cauterize specific abnormalities under direct visualization. The hysteroscope is also valuable in treating some forms of tubal occlusion.

What should I expect after a Hysteroscopy?

Complications are infrequent from hysteroscopy. Some patients may experience mild cramping. This usually is the result of the need to dilate the cervix for insertion of the scope. In general, patients are able to return to their normal activity level in 1-2 days after surgery.

What are the possible risks after a Hysteroscopy?

The possible risks of hysteroscopy include bleeding, infection and uterine perforation. Fortunately, these risks are infrequent. Occasionally, Gynaecologists utilize a simultaneous Laparoscopy to aid in the prevention of uterine perforation if extensive hysteroscopy surgery is planned.

What are the advantages of a hysteroscopy over a plain D&C?

Nowadays it is rare for a D&C to be done alone. It is usually combined with a hysteroscopy. This is because it is conclusively proven that a D&C [which is really a "blind" procedure] even in the best of hands gets only about 50% of the lining of the uterus while there may be a disease in the remaining portion which has been missed.A hysteroscopy allows the gynaecologist to view the inside of the uterus and take a biopsy from the area which is worst affected and to localize the area and extent of the disease too.