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Laparoscopy

Laparoscopy is a procedure used in the diagnosis and management of problems in gynecology including infertility. It is performed using an instrument called the laparoscope, which is a slender miniature telescope with a light source. It enables visual inspection of the pelvis and abdomen. Laparoscopy is a fairly safe and simple daycare procedure.
Indications
• Detection of abnormalities in any of the pelvic organs (uterus, tubes and ovaries). Examples – endometriosis, uterine fibroids and presence of adhesions in the pelvis.
• Diagnosis of unexplained pelvic pain.
• Removal of an intrauterine contraceptive device (e.g.:Cu-T) that has entered the abdominal cavity from the uterus.
• To assess patency of the fallopian tubes, i.e. whether the tubes are blocked or open.
Generally laparoscopy does not form the first line of investigation in infertility.

Relative contraindications
• Pregnancy
• Infection in the abdomen or pelvis.
• Severe heart disease
• Relative contraindications are obesity (>100kg) and previous multiple abdominal surgeries.

Procedure
• Prior to the procedure, the woman is required to undergo some blood and urine tests to confirm overall good health.
• The woman comes in the morning after an overnight fast.
• Laparoscopy is better performed under a short acting general anesthesia.
• The woman is appropriately positioned and the procedure is carried out under aseptic precautions.
• A small nick is made on the abdomen, below the umbilicus, through which a special slender needle is inserted into the abdominal cavity. Carbon dioxide is passed through the needle in order to distend the abdomen and move away the bowels, for easy visualization of all the organs.
• The needle is removed and the laparoscope is introduced through the same incision. The uterus, tubes, ovaries and the pelvis are visualized through the laparoscope.
• The dye test is carried out with the laparoscope still in place.
• Distilled water mixed with a few drops of a dye called methylene blue is slowly instilled into the uterus through a cannula or hollow tube passed into the uterine cavity via the vagina and cervix.
• Passage of this blue colored fluid through the tubes and its subsequent spill from the outer ends into the pelvic cavity is visualized through the laparoscope. This confirms whether the tubes are patent (open) or not.
• At the end of the procedure the carbon dioxide that has been instilled is made to escape from the abdomen (as much as possible) by gently pressing the sides of the abdomen.

Operative Laparoscopy
Operative procedures are performed by the introduction of accessory instruments into the abdominal cavity in a manner similar to the introduction of the laparoscope. These instruments either hold, cut or burn tissues. The procedure is monitored on a screen by means of a video camera attached to the laparoscope. Some of the procedures that can be performed are:
• Removal of adhesions in the pelvis.
• Removal of uterine masses in the uterus, tubes or ovaries.
• Removal of an unruptured tubal pregnancy

After care
• The patient is given antibiotics to prevent any infection, and analgesics to relieve pain.
• Oral intake is begun 2-4 hours later.
• The patient is allowed to leave 4-6 hours later.
• There may be pain in the shoulders or a sensation of bloatedness due to remaining gas in the abdomen. This settles within a day or so, as the gas is slowly absorbed.
• Normal work may be resumed after a day’s rest.

Complications
Complications are rare and may include:
• Accidental entry into a blood vessel or bowel or any of the pelvic organs. Management will involve abdominal surgery i.e. opening of the abdomen and repairing the defect.
• Entry of air into a blood vessel and thus into the blood circulation, termed as embolism. This is an emergency and will require intensive care.
• Infections

This is some background information about the procedure. If you have any further queries, please approach the front desk to schedule an appointment with one of our doctors. We would be happy to be of assistance.

 
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