Laparoscopy and hysteroscopy | More information | FAQ | Invia fertility (2023)

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A comprehensive examination of the inside of a woman's pelvis can provide important information about infertility and common gynecological disorders. Often, problems that cannot be detected by external physical examination can be detected by laparoscopy and hysteroscopy, two procedures that allow direct visualization of the pelvic organs. If you have infertility, these procedures may be recommended as part of your infertility diagnosis and care.difficulty getting pregnant, depending on your specific situation. Laparoscopy and hysteroscopy can be used for diagnostic (examination only) and surgical (examination and treatment) purposes.

A diagnostic laparoscopy may be recommended to examine the outside of the uterus, fallopian tubes, ovaries, and the inside of the pelvis. Diagnostic hysteroscopy is used to examine the inner cavity of the uterus. If abnormalities are found during the diagnostic process, they can often be corrected with simultaneous surgical laparoscopy or surgical hysteroscopy, thus avoiding the need for another operation. Both diagnostic and surgical procedures should be performed by doctors with surgical experience in these fields. The following information will help patients understand what to expect before any of these procedures.

diagnostic laparoscopy

Laparoscopy can help doctors diagnose many gynecological problems, including endometriosis, fibroids and other structural abnormalities, ovarian cysts, adhesions (scar tissue), and ectopic pregnancy. Your doctor may recommend this surgery as part of your evaluation if you have pain, a history of previous pelvic infections, or symptoms suggestive of pelvic disease. Laparoscopy is sometimes recommended after an initial evaluation of infertility in both partners. It is usually done shortly after the end of menstruation.

Laparoscopy is usually performed on an outpatient basis under general anesthesia. After the patient receives general anesthesia, a needle is inserted through the navel and the abdomen is filled with carbon dioxide. The gas pushes the internal organs away from the abdominal wall so that the laparoscope can be safely inserted into the abdominal cavity, reducing the risk of injury to surrounding organs such as the intestines, bladder, blood vessels, etc. The laparoscope is then inserted through an incision in the belly button. Sometimes an alternative site for inserting the laparoscope is used, depending on the doctor's experience or the patient's previous surgery or medical history.
When viewed through a laparoscope, doctors can see the reproductive organs, including the uterus, fallopian tubes, and ovaries (Figure 1). Usually, a small probe is inserted through another incision over the pubic area to clearly see the pelvic organs (Figure 2). Also, a solution containing a blue dye is usually injected through the cervix, uterus, and fallopian tubes to see if they are open. If no abnormalities are found at this point, the incision is closed with one or two stitches. If defects or abnormalities are found, diagnostic laparoscopy can be converted to operative laparoscopy.

Picture 1. Laparoscopic observation of female internal reproductive organs.

Figure 2. Diagnostic laparoscopy.

laparoscopic surgery

During laparoscopic surgery, many abdominal disorders can be safely treated laparoscopically while the diagnosis is made. When performing laparoscopic surgery, doctors insert additional instruments such as probes, scissors, grasping instruments, biopsy forceps, electrosurgical or laser instruments, and suture material through two or three additional incisions. Although lasers are useful in some procedures, they are expensive and not necessarily better or more effective than other surgical techniques used in laparoscopic surgery. The choice of technique and instruments depends on many factors, including the experience of the clinician, the location of the problem, and the availability of equipment.

Some of the problems that can be corrected with laparoscopic surgery include removing adhesions around the fallopian tubes and ovaries, opening blocked fallopian tubes, removing ovarian cysts, and treating ectopic pregnancy. Endometriosis can also be excised or removed outside the uterus, ovaries, or peritoneum. In some cases, uterine fibroids can also be removed. Surgical laparoscopy can also be used to remove diseased ovaries and can assist with hysterectomy.

Risks of laparoscopy

There are risks associated with laparoscopy. The most common are postoperative bladder infections and skin irritations. Adhesions may occur. A hematoma of the abdominal wall may develop near the incision. Pelvic or abdominal infection may occur.

Serious complications of diagnostic and surgical laparoscopy are rare. The main risk is damage to the intestines, bladder, ureter, uterus, large blood vessels or other organs, which may require further surgery. Injuries can occur during the introduction of various instruments through the abdominal wall or during surgical procedures. Certain conditions can increase the risk of serious complications. These include previous abdominal surgery, especially bowel surgery, history or presence of bowel/pelvic adhesions, severe endometriosis, pelvic infection, obesity or excessive wear.

Rarely, anaphylaxis, nerve damage and anesthesia complications occur. Postoperative retention of urine is rare, as is venous thrombosis. The risk of death from laparoscopy is very small (about 3 in 100,000). When all possible complications are considered, 1 to 2 in 100 women may develop complications, usually with mild consequences.

postoperative care

After laparoscopy, the navel area is often tender and the abdomen may be bruised. The gas used to expand the abdomen can cause discomfort in the shoulders, chest and abdomen, and the anesthesia can cause nausea and dizziness. Discomfort depends on the type and extent of the operation. Normal activities can usually be resumed within a few days.

Significant abdominal pain, worsening nausea and vomiting, a temperature that reaches 101°F or higher, or profuse bleeding from an incision are potentially serious complications that require immediate medical attention.

Consider laparoscopy versus laparotomy in pelvic surgery

Many gynecological operations are performed by laparotomy, in which an incision is made ("bikini" or "top and bottom") to open the abdomen. After surgery, patients generally stay in the hospital for a few days and can return to work within two to six weeks, depending on the level of physical activity required. Many gynecological operations can also be performed laparoscopically. After laparoscopic surgery, patients can usually go home on the day of surgery.
Faster recovery, return to full activity within three to seven days. Certain types of surgery may be too risky to perform laparoscopically, and for others it is not clear whether laparoscopic surgery works as well as laparotomy. The surgeon's experience also plays an important role in the decision about laparoscopy or laparotomy. When considering gynecological surgery, the patient and her physician should discuss the advantages and disadvantages of performing laparotomy versus laparoscopy.

diagnostic hysteroscopy

Hysteroscopy is a useful method for evaluating women with infertility, recurrent miscarriages, or abnormal uterine bleeding. Diagnostic hysteroscopy is used to examine the uterine cavity (Figure 3) and is useful in diagnosing uterine abnormalities such as internal fibroids, scars, polyps, and congenital malformations. Before the hysteroscopy, hysterosalpingography (X-ray examination of the uterus and fallopian tubes), hysterosalpingography (ultrasound during which saline solution is introduced into the uterine cavity) or endometrial biopsy can be done to evaluate the uterus.

The first step in a diagnostic hysteroscopy usually involves gently stretching the cervical canal using a series of dilators to temporarily enlarge the opening of the cervix. After the cervix is ​​dilated, a hysteroscope (a long, thin, lighted telescope-like instrument) is inserted through the cervix into the uterus. Hysteroscopy does not require a skin incision. Carbon dioxide or a special liquid is then injected into the uterus through the hysteroscope. This gas or liquid expands the uterine cavity, allowing the doctor to directly see the internal structures of the uterus.

Diagnostic hysteroscopy is an outpatient procedure performed in a doctor's office or operating room. It is performed shortly after the end of menstruation because it is easier to assess the uterine cavity (Figure 4).

surgical hysteroscopy

Surgical hysteroscopy can treat many abnormalities detected during diagnostic hysteroscopy. Surgical hysteroscopy is similar to diagnostic hysteroscopy, except that narrow instruments are placed into the uterine cavity through channels in the surgical hysteroscope. Fibroids, scar tissue and polyps can be removed from inside the uterus. Congenital anomalies, such as a uterine septum, can be corrected by hysteroscopy.

Your doctor may want you to take medication to prepare for your uterine surgery. At the end of the procedure, your doctor may insert a Foley catheter or other device into your uterus. Antibiotics and/or estrogens may be prescribed after certain types of uterine surgery to prevent infection and promote endometrial healing. Endometrial ablation, a procedure that destroys the lining of the uterus, can be used to treat some cases of excessive uterine bleeding. Endometrial ablation is not performed on women who want to become pregnant.

picture 3. diagnostic hysteroscopy

Figure 4. normal uterine cavity

Risks of hysteroscopy

Complications of hysteroscopy occur in approximately 2 out of 100 procedures. Uterine perforation (a small hole in the uterus) is the most common complication. Although the perforation usually closes on its own, it can lead to bleeding or damage to nearby organs, which may require further surgery. Adhesions or uterine infection may develop after hysteroscopy. Serious complications associated with fluid distending the uterus include fluid accumulation in the lungs, clotting problems, fluid overload, electrolyte imbalances, and serious allergic reactions. However, serious or life-threatening complications are very rare. Some of the complications mentioned above can prevent the surgery from being performed.

postoperative care

After hysteroscopy, there may be vaginal discharge or bleeding and cramping for a few days. Most physical activity can usually be resumed in a day or two. You should ask your doctor when to resume intercourse. If the Foley catheter remains in the lumen, it is usually removed after a few days. You may need to take estrogen for a few weeks after surgery.

in conclusion

Laparoscopy and hysteroscopy allow doctors to diagnose and correct many gynecological conditions on an outpatient basis. The patient's recovery time is short and significantly shorter than abdominal surgery through a larger incision. Before undergoing laparoscopy or hysteroscopy, patients should discuss with their doctor any concerns they may have about the procedure and its risks.

Glossary

Accession. Bands of fibrous scar tissue that may bind the pelvic organs and/or loops of bowel. Adhesions can be caused by a previous infection, endometriosis or surgery.

biopsy. A tissue sample is taken for microscopic examination. The term also refers to tissue that is removed during surgery.

cervix. The narrow lower part of the uterus that opens into the vagina. The cervical canal passes through the cervix and connects the cervix with the uterine cavity. Congenital. Present at birth (birth defect).

diagnostic hysteroscopy. A long, lighted, telescope-like instrument called a hysteroscope is inserted through the cervix into the uterus to detect abnormalities inside the uterus.

diagnostic laparoscopy. A long, thin, lighted, telescope-like instrument called a laparoscope is inserted through the belly button and into the abdomen to look for abnormalities in internal pelvic organs, such as the outside of the uterus.

dilator. An instrument used to enlarge small openings.

ectopic pregnancy. A pregnancy that develops in an abnormal location outside the uterine cavity, usually in the fallopian tubes.

electrosurgical instruments. A surgical instrument that uses electric current to open (cut) and remove unwanted tissue.

endometrial biopsy. A tissue sample from the lining of the uterus (endometrium) is taken and examined under a microscope.

ENDOMETRIOSIS. Small implants of endometrial tissue (endometrium) in abnormal locations outside the uterus, such as the ovaries, fallopian tubes, and abdominal cavity. Endometriosis can cause pain, adhesions and infertility. endometrium The lining of the uterus thickens every month in preparation for a fertilized egg. Without fertilization, excess mucus is shed (menstruation). oviduct. Two tube-shaped organs are attached to the uterus, one on each side, where the sperm and egg meet during normal fertilization.

Probe de Foley. A catheter held in the bladder, usually by a balloon filled with air or fluid; it is also kept in the uterus to prevent scar tissue from forming after uterine surgery.

hematoma. Localized bleeding oozes from a blood vessel into tissue, like a large bruise.

hysterectomy. Surgical removal of the uterus. Hysterectomy can be performed through an incision in the abdomen (laparotomy) or through the vagina (vaginal hysterectomy). Sometimes the ovaries and fallopian tubes are also removed. Hysterosalpingography. A procedure in which a special solution visible on X-rays is injected through the cervix to show the internal contours and patency (patency) of the uterus and fallopian tubes.

hysteroscopy. A thin, lighted telescope-like viewing instrument that is inserted through the cervix to examine the inside of the uterus during a hysteroscopy.

hysteroscopy. A surgical procedure for inserting a hysteroscope through the cervix into the uterine cavity.

laparoscopy. A thin, lighted telescope-like viewing instrument that is inserted through the navel and abdominal wall to view the female reproductive organs and abdominal cavity during laparoscopy.

laparoscopy. A long, thin, lighted, telescope-like instrument (called a laparoscope) is inserted through an incision in the abdomen to look for abnormalities in the internal sex organs and, in some cases, to correct them surgically.

laparotomy. Abdominal surgery is performed through an incision on the abdominal wall.

hysteroscopic surgery. Surgery on the uterus using a hysteroscope and other long, thin instruments, such as removing adhesions or tumors.

laparoscopic surgery. Surgery performed inside the abdomen with a laparoscope and other long, thin instruments, such as to remove adhesions or endometriosis. Ovarian cyst. Ovarian cyst filled with fluid.

ovaries. The two female reproductive organs in the pelvis produce eggs, as well as the female hormones estrogen and progesterone.

peritoneum. A smooth, transparent membrane lining the abdominal and pelvic cavity.

polyp. A general term describing any mass of tissue that protrudes or protrudes horizontally outward or upward from the normal surface.

Dantian. The area above the vaginal opening in the lower abdomen is partially covered with hair.

dress. Suture used to close the incision during surgery. Generally, it can be absorbed. ureter. Tubes that connect each kidney to the bladder.

urinary retention. Impossibility of spontaneous bladder emptying.

uterine fibers. An abnormal mass of smooth muscle tissue that grows on the wall of the uterus. Also known as fibroids or leiomyomas.

uterine septum. A birth defect caused by a band of tissue in the middle of the uterus that separates the normal uterine cavity.

Uterus. A hollow, muscular female organ in the pelvis where the embryo implants and develops during pregnancy.

venous thrombosis. Blood clots in the veins.