Laparoscopic surgery at a glance
- Laparoscopy is a minimally invasive surgical technique that uses small incisions in the abdomen and a thin instrument with a fiber-optic camera on one end to provide the surgeon a view of the operating area on a video monitor.
- Laparoscopy is used to diagnose and treat a multitude of reproductive problems that can cause infertility including blocked fallopian tubes, ovarian cysts, endometriosis, ectopic pregnancy and unexplained infertility.
- Laparoscopic surgery is safer, less expensive and has shorter recovery time than surgery performed via laparotomy, which requires a much larger incision.
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What is laparoscopy for infertility?
Laparoscopy is a minimally invasive surgical procedure that uses a small camera to examine the reproductive organs through small incisions in the abdomen. During a laparoscopy, the surgeon can see the outside of the uterus, ovaries and fallopian tubes.
Laparoscopy can be diagnostic to view inside the pelvic area and identify a condition that needs to be addressed or to determine that no condition exists. If a condition such as endometriosis is identified, the surgeon can also correct the problem at that time using special instruments inserted through the laparoscope.
Laparoscopic procedures are generally “same-day” procedures. The patient comes in and is discharged on the same day. The procedure itself can take anywhere from 45 minutes to 3 hours, depending on whether or not further surgery is performed after identifying a problem to correct and to the extent of that surgery.
How is laparoscopic surgery performed?
During a laparoscopic procedure, the surgeon will make two or more small incisions measuring about a quarter inch across. The first incision is typically made in the navel and the second in the lower abdomen.
Once the incisions have been made, the surgeon will release carbon dioxide gas into the abdomen. This expands the abdomen and makes the pelvic organs easier to view with the camera.
With the abdomen expanded, the surgeon inserts the laparoscope through the navel incision to examine the uterus and/or other reproductive organs in the pelvic area. The surgeon inserts special operating instruments into the abdomen through the smaller surrounding incisions.
After the surgeon has thoroughly examined the pelvis, he or she will remove any adhesions, cysts or abnormalities discovered. Once the surgery is complete, the gas is removed and the incisions are closed with absorbable stitches or with special glue.
The number of incisions needed, surgical technique and instrumentation used during each laparoscopic procedure vary depending on the physician’s experience and preferences, the condition diagnosed, the location of the problem, and equipment available.
Laparoscopy for specific causes of infertility
Laparoscopy is both a diagnostic and surgical tool in women experiencing infertility. Some reproductive problems that can cause female infertility and can be corrected with operative laparoscopy include the following.
- Removing adhesions from around the fallopian tubes and ovaries.
- Opening blocked fallopian tubes.
- Removing ovarian cysts.
- Treating ectopic pregnancy.
- Removing endometriosis from the outside of the uterus, the ovaries and other areas of the abdominal cavity.
- Under certain circumstances, removing uterine fibroids (specifically subserous fibroids that bulge out away from the inside of the uterus).
- Removing diseased ovaries.
Laparoscopy can also be used to perform a hysterectomy or to assist in one.
Diagnosing unexplained infertility via laparoscopy
Laparoscopy can also be used to try to identify some causes of unexplained infertility, a diagnosis given when no apparent cause of existing infertility has been determined by examination or tests.
For example, a surgeon can check the function of the fallopian tubes by passing dye through the fallopian tubes during a laparoscopic diagnostic procedure. If the dye moves through the fallopian tubes, the fallopian tubes are not blocked and another cause of infertility is likely present.
Laparoscopy versus laparotomy
Many gynecologic operations are still performed via laparotomy, which requires an incision that is several inches long in the “bikini” area of the lower pelvis (compared with the multiple incisions that are about a quarter inch long used during laparoscopy). Laparotomy incisions are made in the abdomen for diagnosis or in preparation for open surgery. Patients require longer recovery time after a laparotomy and will need to stay in the hospital in the days following their procedure.
Though laparoscopy has become a standard for pelvic surgery, the surgeon may recommend laparotomy in cases where laparoscopy may be too risky or require more extensive repairs, specifically in cases where the surgeon needs more space to work.
The surgeon’s experience also plays a role in deciding whether operative laparoscopy or laparotomy should be used. When considering a gynecologic operation, the patient and her doctor should discuss the pros and cons of performing a laparotomy versus an operative laparoscopy.
Risks of laparoscopic surgery
Any type of surgery has some potential risks. Common risks of laparoscopic pelvic surgery include:
- Post-operative infection.
- Skin irritation.
- Allergic reactions.
- Nerve damage.
- Anesthesia complications.
Though quite rare, there is also some risk that one of the abdominal or pelvic organs, including the bowel, bladder or blood vessels, may be injured when the laparoscope or one of the instruments is placed. This is more common in women who have had previous abdominal surgery, pelvic adhesions, or who are overweight but may occur in any patient.
Contact us to schedule an appointment with our reproductive specialists and learn if you are a candidate for laparoscopic surgery.