DIAGNOSTIC LAPAROSCOPY & HYSTEROSCOPY
In this page we will discuss in details Laparoscopy and Hysteroscopy. We will cover various topics that will help you select the surgery that suites you the best. We will discuss these headings:
What is diagnostic laparoscopy?
Diagnostic laparoscopy is a surgical technique used to view the internal organs of the abdomen in order to identify a specific disease process. On this page we will restrict ourselves to the use of diagnostic laparoscopy and diagnostic hysteroscopy in gynaecology and infertility.
Dr Mayur Pai is very experienced in performing laparoscopic and hysteroscopic procedures.
When should you undergo diagnostic laparoscopy?
A woman may be advised gynaecologic laparoscopy if she is suffering from infertility, chronic pelvic pain, unknown pelvic mass or fluid collection in the pelvis. Many gynaecological diseases can be diagnosed by diagnostic laparoscopy like fallopian tubal pathology (like ectopic pregnancy, blocked tubes and infected tubes), ovarian pathologies (like ovarian tumors, chocolate cyst of ovary, adhesions due to endometriosis and infections), uterine pathologies (like fibroids and surface adhesions),and pelvic conditions like endometriosis and infections to name a few.
What tests are performed before laparoscopy?
Before laparoscopy, the doctor may advice for some basic blood tests and ultrasound of the pelvis. Any additional tests for patient safety and supportive of the diagnosis may also be ordered.
How does one prepare for laparoscopy surgery?
The patient is usually admitted one night prior to the day of laparoscopy. She is given few medications to ensure a safe and easy laparoscopy. Patient may be given sedatives to help her sleep well and decrease anxiety.
How is laparoscopy performed?
Before a laparoscopic procedure, a pre anaesthetic check-up is done. A pre anaesthetic evaluation is done by the anaesthesiologist.
An anaesthesiologist is a specialist doctor who administers the anaesthesia. During diagnostic laparoscopy, the patient is put under general anaesthesia. This means that she will be sleeping and unaware of any pain and discomfort during the procedure. She will also not remember the procedure or any discomfort related to the surgery.
After the patient is under anaesthesia, the surgeon gains access to the abdomen through a small incision of about 1 cm near the umbilicus. This is called the laparoscopic port. Carbon dioxide gas is pumped in to the abdomen to allow the surgeon to perform laparoscopy. Carbon dioxide has been proven to be very safe for laparoscopy use since many years. The surgeon inserts a high definition camera through the laparoscopic port and the view of the abdominal organs is projected on a medical monitor.
What all additional procedures can be performed during a diagnostic laparoscopy?
The ability to perform additional procedures during diagnostic procedures is one of the many benefits of laparoscopic surgery. These additional procedures are part of operative laparoscopy.
The laparoscopic surgeon may also insert additional ports in order to insert additional instruments that help in better vision and manipulate the various organs under study. The surgeon can also take biopsies and cut adhesions in the pelvis.
In cases of infertility, we frequently perform tubal patency test with methylene blue dye. The spill of the dye through both the fallopian tubes is seen and that confirms a freely patent tube. In case a block is found in the fallopian tube, efforts are made to open the blocked fallopian tube by various techniques.
Patients with PCOS may undergo PCOD drilling at the same time as a diagnostic laparoscopy. This saves the patient time and financial resources by combining the procedures.
How does the patient feel at the end of laparoscopy?
After diagnostic laparoscopy is over, the carbon dioxide gas is evacuated from the abdomen and all the ports are removed under vision by a standard technique.
The laparoscopic ports are sutured with a thin cosmetic suture and bandage dressing applied. The patient usually wakes up completely within a few minutes of the surgery and is well oriented. She is observed in the recovery room for a few hours. She may be discharged on the same day or the next day. The patient is able to walk and pass urine in the bathroom on her own in a few hours of the surgery. We do not catheterize the patient for an uncomplicated gynaecologic laparoscopy.
What are the advantages of laparoscopy over open surgery?
Laparoscopy or key hole surgery has several advantages like better cosmetic outcome, quicker healing, lesser blood loss, lesser pain and more precise surgery due to magnification.
In cases of infertility, laparoscopy is considered gold standard the world over. Laparoscopy has found a place in routine abdominal and even cancer surgeries.
Can diagnostic laparoscopy be combined with hysteroscopy?
Diagnostic laparoscopy is many times combined with diagnostic hysteroscopy especially in cases of infertility. A diagnostic hysteroscopy can also be carried out on its own without laparoscopy.
What is diagnostic hysteroscopy?
Diagnostic laparoscopy is usually done under short general anaesthesia. The patient is put to sleep and the procedure begins. An instrument called a hysteroscope is used to view the inner aspect of the uterus. The hysteroscope enters the vagina, then the cervix and then into the uterine cavity. There is no need for an incision. The surgeon sees a highly magnified view of the endometrial cavity which includes the openings of the fallopian tube in the uterus. The surgeon can visualise the area where the embryo implants. Any suspicious areas can be sampled and any tumors can be removed in the same sitting.
Diagnostic hysteroscopy lasts for 5 to 15 minutes and the patient wakes up within a few minutes of the procedure. The patient is able to walk unassisted and pass urine in the bathroom on her own. Almost all patients of diagnostic hysteroscopy are discharged within a few hours after observation.