Endoscopic surgery: hysteroscopy and laparoscopy (2023)

Endoscopy is a technique that involves inserting a tube connected to a camera (endoscope) to look inside an organ or cavity. The device is inserted through a small incision or natural opening, such as the vagina or anus.

Until recently, these programs were useddiagnosisjust for reference. Today, however, the endoscopic approach also allows for correctionbaveTreat the pathology in a less aggressive way.

Gynecological endoscopy does not require hospitalization, and patients can go home on the day of the procedure. Two ways can be distinguished between them:Hysteroscopy and laparoscopy.

What is endoscopy?

Endoscopy is a diagnostic procedure that involves the introduction ofnatural hole or small incisionLook inside an organ or cavity. In this way, information can be obtained that cannot be reliably provided by other external techniques such as X-rays. It is a surgical procedure that is performed when:local or regional anesthesia or sedation.

An endoscope is an instrument consisting of a lighted tube that is inserted into a cavity or canal for observation.

Gynecological endoscopic surgery is an emerging discipline with two purposes: diagnosis and treatment of pathology. In this case, to visualize the female genital cavity, the endoscope can be introduced in two ways:

• Through the vagina (hysteroscopy).
• through a small incision in the abdomen (laparoscopy).

Advantages of endoscopic surgery

Endoscopic surgery is considered the technique of choice in some situations due to multiple advantages:

• Get well soon.
• hospital for several hours.
• The scars are smaller.
• There is less possibility of bleeding and blood loss.
• If the woman is not sedated, there will be communication between the patient and the doctor during the test.

Due to the mentioned characteristics, the endoscopic technique is calledminimally invasive surgery.

gynecological hysteroscopy

Hysteroscopy is a technique for diagnosing and treating pathologies of the uterine cavityuterine cavityBy direct visualization. A small hysteroscope (3-5 mm) is introduced through the opening of the cervix. In addition, carbon dioxide or saline must be injected to expand the cavity.

A hysteroscope is a thin gynecological instrument that can be rigid, semi-rigid or flexible.

Depending on the purpose and thickness of the hysteroscope, there are two types of hysteroscopy:Diagnosis and surgery. In both types, women are in a gynecological position. The doctor then places a speculum to widen the opening of the vagina and cleans the cervix with an iodine solution.

After cleaning the area, the doctor gently inserts the hysteroscope into the cervix, releasing fluid to dilate the area, which will help to clearly see the uterine cavity. With the help of the monitor, the specialist will examine the uterus in detail. Also, if the procedure is done to treat an injury, additional instruments will be inserted through the hysteroscope.

Below we list each type of hysteroscopy.

diagnostic hysteroscopy

In this hysteroscopic model,smaller caliberHysteroscopy is performed on an outpatient basis without anesthesia and sedation.

The optimal time for hysteroscopy in patients of reproductive age isproliferation phasefrommenstrual cycle, that is, between the sixth and tenth day. This reduces bleeding andendometriumthinner.

Diagnostic hysteroscopy is indicated when:

• When the uterus attaches,endometrial polyps,fibroidsOr suspected uterine septum.
• When coils and other devices are removed.
• For testing infertility and implantation failure.
• Assess menstrual changes.
• Evaluation of the endometrial cavity.

Using this technique ensures good reliability of image interpretation,minimize, in turn, the risk of complications. However, secondary complaints may occur, such as pain in the pelvis or abdomen.

hysteroscopic surgery

This model of hysteroscopy is performed when any endometrial or uterine changes are diagnosed.

In hysteroscopic surgery, the hysteroscope isfatterIt is performed in the operating room under sedation or regional anesthesia.

Furthermore, hysteroscopes are equipped with gynecological tools to perform various types of procedures, whether they require resection or manipulation. In addition, the cervix must be more dilated in surgical hysteroscopy than in diagnostic hysteroscopy.

Cases requiring hysteroscopic surgery are described below:

• Ablation or reduction of the endometrium.
• Removal of fibroids or polyps.
• Eliminate intrauterine adhesions.
• Hysterectomy.

risk

Thanks to technological progress, hysteroscopy has become a fundamental technique in gynecological practice.

In general, hysteroscopy is considered a safe technique, so the chances of complications are low, but not impossible. There is a small chance that the uterus will perforate and cause bleeding.

Other complications of hysteroscopy are described below:

• reflex syncope: due to inexperience and the diameter of the hysteroscope. This complication usually causes a feeling of discomfort, warmth and paleness.
• gas embolism: Serious but unusual. This is a side effect of carbon dioxide expansion.
• pelvic infection.

Therefore, it is crucial to notice the signs of complications in order to avoid endangering a woman's health.

Contraindications for hysteroscopy

Although hysteroscopy is one of the main techniques in gynecology, there are certain situations in which it should not be performed. Some of them are described below:

• In women in the acute phase of pelvic infection, the endometrium or fallopian tubes may spread.
• Excessive bleeding from the uterus because it prevents accurate visualization of the area.
• Cervical cancer.
• The beginning of evolution.

Exceptionally, a pregnant woman can undergo a hysteroscopy to remove the spiral, provided that this is done before the 10th week of pregnancy.

gynecological laparoscopy

Laparoscopy is a surgical procedure to detect problems in the abdomen or the female reproductive system (uterus, fallopian tubes and ovaries). A thin tube (laparoscopy) is inserted through a small incision in the navel. It is a minimally invasive technique so that patients can return to their daily lives72-78 sati.

Gynecological laparoscopy requires the patient to fast the day before the procedure and take laxatives to empty her bowels.

Like hysteroscopy, laparoscopy has two simultaneous goals: on the one hand, the examination is aimed at diagnosis, and on the other hand, it solves problems that arise during the intervention.

diagnostic laparoscopy

Recovery from this procedure is quick and painless. Laparoscopy is necessary for diagnosis when the following are suspected:ENDOMETRIOSIS, infertility, bleeding from the ovaries and pain in the abdomen and pelvis, for which no explanation could be found.

The time of diagnostic laparoscopy always depends on the purpose and opinion of the specialist.

laparoscopic surgery

Today, laparoscopic surgery is a fairly safe surgical method of treating gynecological diseases. For this, doctormali groundThrough this procedure, a trocar will be inserted so that you can use surgical tools such as scissors, forceps, etc.

The procedure is performed under general anesthesia so that the woman does not feel pain during the procedure. Most gynecological reconstructive surgeries can be performed laparoscopically. Below we will consider in detail the main indications for laparoscopic surgery:

• Removal of ovarian cyst from uterine fibroids.
• Treat endometriosis.
• eliminateectopic pregnancy.
• Hysterectomy or hysterectomy.

When patients undergo laparoscopic surgery, they must take antibiotics before surgery to reduce the risk of infection.

recovery

Women who undergo laparoscopy recover quickly, often with some medicationanalgesic.

Another aspect of recovery that can be changed is the use of carbon dioxide for better visualization, as this gas can cause abdominal discomfort in the first few days after surgery. This is completely normal and the symptoms will disappear as the carbon dioxide is absorbed. As for sexual activity, women can have intercourse after the bleeding stops.

Risks of laparoscopy

As with any other surgery, laparoscopy can cause some complications. Common risks include bleeding at the insertion site or incorrect application of visualization gas.

Other risks of gynecological laparoscopy are:

• Damage to the inside of the stomach, intestines, bladder or ureters.
• Adverse reactions to anesthesia.
• blood clot
• Swollen belly.

Frequently asked user questions

Can uterine fibroids be removed laparoscopically?

Daniel Sosa, MD, MS (gynecologist).

Yes, in skilled hands, the laparoscopic approach can be used to resect subserosal and intramural fibroids.

However, the fibroids most associated with reproductive problems are submucosal fibroids, which can be removed by hysteroscopy.
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Can hysteroscopy be done during menstruation?

Author: Marta Barranquero Gómez BSc, MSc (embryologist).

Not. Hysteroscopy is usually performed during the proliferative phase of the menstrual cycle, but can be performed at any stage of the cycle when the patient is not bleeding and pregnancy is unlikely.

Is gynecological hysteroscopy painful?

Author: Marta Barranquero Gómez BSc, MSc (embryologist).

Diagnostic hysteroscopy is usually painless, but period-like discomfort may occur after the procedure.

There is no pain during hysteroscopy because it is done under anesthesia.

What are the recommendations after hysteroscopy?

Author: Marta Barranquero Gómez BSc, MSc (embryologist).

In general, patients should avoid bathing, but showering is acceptable. Also, sex is not recommended for about two weeks.

Bed rest is not necessary, but rest in the first 24 hours is necessary.

If your abdominal discomfort is similar to menstruation, you can take painkillers.

Are hysteroscopy and ultrasound the same?

Author: Marta Barranquero Gómez BSc, MSc (embryologist).

No. Hysteroscopy and hysterosonography are two different examinations.

Hysteroscopy involves inserting a tube with a camera attached through the cervix (hysteroscopy); A sonohysterogram is a transvaginal ultrasound that uses a catheter to insert a saline solution into the cervix.

recommended for you

Women who have difficulty conceiving due to problems with the uterus will be advised to have a gynecological endoscopic examination. You can read more about it in the following articles:

Hysteroscopy is also one of the examinations to assess a woman's fertility. You can learn more about other complementary techniques in the following articles:Fertility tests in women - How can I know if I am infertile?

If you want to check the patency of the fallopian tubes, see:How is a hysterosalpingogram (HSG) performed?