Operative Laparoscopy
Operative laparoscopy offers a safe treatment method for many abdominal disorders simultaneously as the diagnosis is made. Operative laparoscopy requires the use of supplementary instruments such as probes, grasping instruments, scissors, biopsy forceps, laser or electrosurgical instruments and suture materials are inserted through two or three additional incisions. Though lasers provide a great deal of help in certain operations they are an expensive option and may not necessarily be a superior or more efficient option compared to other surgical techniques used. The choice of instruments and techniques are largely dependent on factors such as physicians experience, nature and site of the problem, and equipment availability.
Operative laparoscopy can be used in the removal of scar tissue (adhesions) from around the ovaries and fallopian tubes, removing ovarian cysts, opening blocked tubes and treatment of ectopic pregnancy. Ablation or removal of endometriosis from the ovaries, peritoneum or outer surface of the uterus is done. Also helps in the removal of fibroids present on the uterus, under certain circumstances. Diseased ovaries can be removed using this procedure as a part of hysterectomy
Operative Hysteroscopy
Treatment of the abnormalities discovered during diagnostic hysteroscopy is done during operative hysteroscopy. Similar to diagnostic hysteroscopy, operative hysteroscopy additionally uses narrow instruments placed through outlets in the operative hysteroscope into the uterine cavity. Fibroids, polyps and scar tissue can be removed from inside the uterus. It may also help in the correction of certain structural abnormalities, such as a uterine septum.
In order to make the uterus ready for surgery, you may be put on certain medications. A balloon catheter or similar device may be inserted inside the uterus at the conclusion of surgery. In order to prevent infections and to stimulate the healing process of the endometrium your health professional may prescribe antibiotics and/or estrogen after certain types of uterine surgery.
Excessive uterine bleeding can be treated with a procedure known as endometrial ablation. In this process the lining of the uterus is destroyed and is not performed in women who plan to have a pregnancy.
Diagnostic hysteroscopy
Diagnostic hysteroscopy is helpful in the examination of the uterine cavity. It is very useful in the diagnosis of abnormal uterine conditions such as fibroids, polyps, scarring or congenital malformations. Women with a history of recurrent pregnancy loss, infertility or abnormal uterine bleeding may be evaluated using hysteroscopy. In order to evaluate the uterus prior to hysteroscopy, an X-ray of the uterus along with the fallopian tubes (hysterosalpingogram) or sonohysterogram which is an ultrasound done by introducing saline into the cavity of the uterus or an endometrial biopsy may be performed.
In diagnostic hysteroscopy, usually the first step involves stretching the canal of the cervix slightly with a series of dilators. This helps to increase the size of the opening temporarily. On dilation, a thin, long, lighted, instrument like a telescope known as hysteroscope is inserted into the uterus through the cervix. Hysteroscopy does not require skin incisions to be made. Using the hysteroscope special fluid is injected into the uterus. This is done to get a clear picture of the uterus as the fluid expands the cavity of the uterus and provides a good view of the interior of the uterus. This is performed as an outpatient procedure in a physician’s office. It is often performed soon after the menstrual cycle is over since the evaluation of uterine cavity is easier.
Diagnostic Laparoscopy
Most gynaecological problems that include uterine fibroids, endometriosis, ovarian cysts, adhesions (scar tissue), other structural abnormalities and ectopic pregnancy can be diagnosed with the help of laparoscopy. Your physician may recommend this procedure if you have a history of past pelvic infection, pain or symptoms suggestive of pelvic disease. Your physician may also suggest laparoscopy after completing an initial infertility evaluation on both partners. It is usually performed soon after menstruation ends.
Performed under the effect of a general anaesthesia, laparoscopy is usually performed as an outpatient procedure. Through the navel a needle is inserted and carbon dioxide gas is filled in the abdomen. This procedure pushes the abdominal wall away from the internal organs which helps the safe placement of the laparoscope in the abdominal cavity. Through an incision in the navel, the laparoscope is inserted. Depending on the patients earlier surgical or medical history and/or physicians experience alternate sites may also be used occasionally for inserting the laparoscope.
Yet another incision is made in the pubic region usually above it and a small probe is inserted that provides a clear picture of the pelvic organs (Figure 2). Simultaneously a dye is injected through the cervix and then the uterus and into the fallopian tubes to determine if the tubes are blocked. In case of no abnormalities, a couple of stitches or a single stitch may be used to close the incisions. Alternatively, in case of abnormalities, diagnostic laparoscopy may turn to operative laparoscopy.