Laparoscopy is used to evaluate tubal patency and treat a wide spectrum of conditions such as endometriosis, fibroids and adhesions. It is performed under general anesthetic in theater. A small incision is made in the umbilicus. A needle is inserted to allow for gas to be pumped into the abdominal cavity. Once the pressure in the cavity is at approximately 25mmHg a larger trocar is put through the umbilicus to allow a telescope into the abdomen.The telescope is connected to a light source and a camera. Two to three further ports are placed in the abdominal wall to allow access for instruments. Patients usually stay one night in hospital, but may well be discharged on the same day or stay an extra night should it be necessary.
The benefits of Laparoscopic Surgery are:
• Better vision for the surgeon
• Shorter hospital stay for the patients
• Less postoperative pain
• Better cosmetic result
Fibroids or myomas are benign tumors of the smooth muscle of the wall of the uterus. Up to 50% of women at the age of 40 would have fibroids. They grow in response to oestrogen. They can lead to a wide spectrum of problems such as infertility, abnormal bleeding and anemia, constipation and bladder symptoms. A myomectomy is the surgical removal of fibroids. It can be done laparoscopically or through an open wound or hysteroscopically.
Endometrial stroma and glands are tissue normally found in the uterine cavity and are discharged every cycle at menstruation. Endometriosis is a disease where endometrial stroma and glands are found in the abdominal cavity. They responds to the hormones in the same way, but at menstruation they remain in the abdomen and cause bleeding and inflammation. This leads to pain and scarring of the abdomen. The symptoms associated with endometriosis are infertility, painful menstruation and pain with sexual intercourse.Endometriosis causes adhesions of the ovaries and fallopian tubes and large cysts in the ovaries, which can affect fertility. Endometriosis should preferably be treated laparoscopically by an expert surgeon. Laparoscopy allows for better visualization and reduces the trauma during surgery and therefore the postoperative adhesions.
Adhesions are formed as a result of injury, infection or conditions such as endometriosis. This can affect the free approximation of the fallopian tubes to the ovaries in order to pick up the oocyte at ovulation. Salpingolysis is the surgical procedure for the freeing of the fallopian tubes.
The fimbrial ends of the fallopian tubes are often blocked and therefore cause infertility. Salpingostomy is the opening of the ends of the tubes and securing them so that they will not merely become blocked again.
When the fallopian tubes have been damaged and are beyond repair fluid may collect in the damaged tubes. The fluid is toxic and if it leaks back into the uterine cavity it can damage healthy embryos in an IVF or ICSI cycle. Salpingectomy is the surgical removal of the tubes to prevent this from happening. The tubes are permanently removed which leaves no other option than IVF/ICSI for future pregnancy.
Reversal of Sterilisation
Patient’s circumstances change and often there is a need for the reversal of sterilisation. This can be done laparoscopically or through open surgery. If patent tubes can be established the chances of pregnancy is 50% in the first year.
Hysteroscopy is used to evaluate the uterine cavity and treat any abnormality of the cavity such as fibroids, adhesions and congenital uterine abnormalities. A small diameter telescope is used to pass through the vagina and the cervical canal and into the uterine cavity. Office hysteroscopy is now practiced throughout the world. This technique allows for hysteroscopy to be done without the need for an anesthetic. Hysteroscopy is an essential tool to evaluate the uterine cavity prior to assisted reproductive techniques.
A polyp is a small growth of the endometrium in the uterine cavity. It is usually benign, but can impair fertility or cause abnormal bleeding. Polypectomy is when the polyp is removed using the hysteroscope. This is usually a day procedure and is associated with minimal pain. Patients can experience some vaginal bleeding for a week or two after the procedure.