Laproscopy
:
Problems that occur with
a woman's reproductive organs sometimes cannot be found by a physical
examination alone. Laboratory tests, X Rays, or Ultrasound may
still leave some uncertainly. When a diagonsis is not possible
from routine investigations, a look inside the body is needed.
Laporsocopy helps not only in diagnosis but can also be used as
a method of treatment in certain disorders.
Indications
Female Sterilization
Infertility
Chronic Abdominal Pain
Tubal Block
Ectopic Pregnancy
Endometriosis
Polycystic Ovaries
Ovarian Cysts
Fibroids
Hysterectomy
The Laparoscopic Procedure
After anesthesia, a needle is inserted through the navel, and the abdomen is filled with carbon dioxide gas. As the gas enters the abdomen, it creates a space inside by pushing the abdominal wall and the bowel away from the organs in the pelvic area allowing a view of the reproductive organs. Next, the surgeon inserts a laparoscope (long thin telescope) through the insertion in the navel. It is connected to a tiny camera which sends images to a television monitor. While looking at the monitor, the surgeon can see the uterus, fallopian tubes, ovaries, and nearby structures. The surgeon can perform the operation viewing into the monitor. Operating instruments like graspers, dissectors, scissors and coagulators are inserted through two or more ½ centimeter sized cannula in the area above the pubis.
Once the procedure is over, the instruments are removed, the gas released, and the incisions closed. A small adhesive dressing is placed over the incisions.
Advantages
Small punctures instead of incisions
Minimal pain
Shorter hospitalization
Quick recovery
Early return to work
HYSTEROSCOPY
Hysteroscopy is used to examine inside the uterus. It is an important tool in the evaluation of infertility or abnormal uterine bleeding.
After dilating the cervix (mouth of the uterus) with a series of dilators, the hysteroscope, a narrow instrument similar to the laparascope, is passed through the cervix into the uterine cavity. A clear solution or carbon dioxide gas is then injected into the uterus which expands the uterine cavity, and enables the surgeon to directly view the interior of the uterus for anything abnormal.
Operative hysteroscopy can treat many of the abnormalities found during diagnostic hysteroscopy at the same sitting. Instruments such as scissors, biopsy forceps, graspers and electrocautery instruments can be placed into the uterine cavity through a channel in the operating hysteroscope.
Indications
Infertility
Recurrent Abortions
Menstrual Problems
- Irregular bleeding
- Excessive bleeding
- Less or absent bleeding
Post-menopausal bleeding
Congenital Abnormalities
Misplaced IUCD
Alternative to Hysterectomy
Recovery
Laparoscopy / Hysteroscopy in experienced hands is an operation with minimal risk. After surgery, the patient is allowed to rest for 2-4 hours to recover from the anesthesia.
After the operation, the patient may feel some discomfort that usually disappears in day :
Mild nausea fro medication/anestheasia
A sore throat if a breathing tube was used during anesthesia
Pains in your neck or shoulders from the gas put inside your abdomen
Pain at the site where the instruments passed through the abdominal wall
Cramps, like menstrual cramps
Discharge like menstrual flow for a day or two.
Most of these minor complaints are gone in a day or two after surgery.
Risks & Complications
Problems with anaesthesia
Laparoscopy
Injury to near by organs
Bleeding
Infection
Hysteroscopy
Perforation of uterine wall
Infection
A mineral imbalance due to absorption of too much of the fluid used to expand the uterus.
Conclusion
Previously, diagnosing and correcting gynaecologic problems required major surgery and many days of hospilitalization. However the laparoscope and the hysteroscope now allow physicians to diagnose and often correct many of these disorders on an out-patients basis. The procedures decrease patient discomfort, significantly reduce recovery time and has minimal risks.
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