What is Laparoscopy?
Laparoscopy is a type of surgical procedure that allows a surgeon to access the inside of the abdomen (tummy) and pelvis without having to make large incisions in the skin. This procedure is also known as keyhole surgery or minimally invasive surgery. Laparoscope is a small tube that has a light source and a camera, which relays images of the inside of the abdomen or pelvis to a television monitor. It allows for detailed inspection of female pelvic organs like the uterus, cervix, fallopian tubes, and ovaries.
Laparoscopy is used as a diagnostic and therapeutic tool in infertility. It can be used to assess the status of the tubes. in this procedure, dye is instilled into uterine cavity to see spillage into pelvic cavity through fallopian tubes. This helps to test the patency of the fallopian tubes which means to check if the fallopian tubes are unobstructed.
The advantage of laparoscopy over other methods of tubal patency procedure is that it allows for corrective procedures or treatments at the same time as the diagnostic procedure. The other advantages are less scarring as the surgical cuts are smaller and a faster recovery time. A due consent form stating all possibilities is a must prior to any such procedure.
Why is Laparoscopy done?
Laparoscopy in infertility patients is often recommended, as it is the most reliable way to check the health of the pelvic organs. Laparoscopy is also done to treat certain conditions such as ovarian cyst, endometriosis, fibroids ,adhesions which can be the cause of infertility.
Risks associated with Laparoscopy
Any surgical procedure has risk but these are relatively minor.
- Minor risk of bleeding- It is very rare and is 1:1000 cases. If there is any doubt of internal bleeding, the Laparoscopy needs to be extended into larger incision called as Laparotomy.
- Infection- Care must be taken during surgery to minimise the infection
- Damage to nearby structures –Reproductive organs are surrounded by other pelvic organs like bladder, ureter and intestines. These structures are vulnerable to damage especially in difficult cases of laparoscopy. These complications are not common and are around 1 in 2000 cases.
- Blood clots (deep vein thrombosis) -There is a subgroup of patients who may be at more risk than others of such complication. Clotting happens when a patient is lying or sitting still for a while post-surgery. It is important to get up and move soon after the surgery to keep the blood in your legs and body flowing.
How Laparoscopy Used to Treat Fertility-related Problems?
Let’s see how laparoscopy can be used to treat various fertility-related problems:-
- Laparoscopy and treatment of Endometriosis
Endometriosis is a condition that can cause painful periods and infertility. It is caused when small amounts of tissue from the lining of the uterus or womb known as Endometrium start settling down in the pelvic cavity. Endometrium travels backwards through fallopian tubes and usually settles around or in the ovaries. When endometrium starts settling down in the ovaries it is known as Endometrioma. Endometrioma can be treated with laparoscopy by using diathermy (electro cautery or heat treatment)
- Laparoscopy and Adhesions(Laparoscopic Adhesiolysis)
The common reasons for adhesion formation in the pelvic cavity are pelvic infection, endometriosis, or previous surgeries. Adhesions are sticky spider webs, which can be thin and flimsy or can be tough and thick. They can cause ovaries, uterus, and fallopian tubes to stick to each other, which in turn can interfere with normal physiology of achieving spontaneous pregnancy.
Laparoscopy is helpful in such cases to free pelvic organs of adhesions. There are chances of recurrence of adhesions.
- Laparoscopy and Ovarian Cyst (Laparoscopic Cystectomy)
Ovarian cyst seen in a pelvic ultrasound is not necessarily an abnormal condition. Ovary has a tendency to make cyst every month under normal conditions. These can be either follicular cysts or corpus luteal cysts. Usually, they regress on their own and require no intervention or treatment. Sometimes, they do not disappear on their own like Endometriotic cysts. In such cases, the cyst needs treatment either in the form of medical or surgical.
Laparoscopy is used in such cases and the aim of these surgeries is to remove only the cyst and preserve the normal ovary as much as possible to preserve the ovarian reserve. In case the ovarian cyst is very big, it is sometimes not possible to preserve the ovary.
- Laparoscopy and Tubal Surgery
Fallopian tubes can be damaged or blocked by past infections or endometriosis or previous surgeries on pelvic organs. Laparoscopy can assist in tubal surgery with aim to open the fallopian tubes and improve the chances of spontaneous conception. It is important to understand that surgery may help to open the fallopian tubes but it may not necessarily help in functioning of the tubes. There can be chances of pregnancy getting stuck in the tube (Ectopic pregnancy). Hence, it’s important to understand about increased risk of ectopic pregnancy with future pregnancies with tubal surgeries.
These surgeries all need an individualized approach to be successful and bring desired results. Dr. Puneet and her team have experience of dealing with numerous such cases over the years and they can provide excellent consultation as well as surgical assistance through premier methods and technologies.