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| Laparoscopy is an outpatient surgical procedure utilized to diagnose and treat a variety of infertility and gynecological conditions including pelvic pain, uterine fibroids, endometriosis, pelvic adhesions and tubal disease. During laparoscopy a thin fiber-optic tube, attached to a video camera, is inserted into the abdomen, through a small incision in the belly button. The surgeon can then evaluate the uterus, ovaries, fallopian tubes, appendix, liver and gallbladder for the cause of pain or infertility. More recently laparoscopy has been applied to general surgical procedures ranging from appendectomy to removal of a spleen or a kidney. |
| Laparoscopic CO2 laser myomectomy |
| »CLICK TO VIEW FIBROID SURGERY |
Uterine fibroids are common benign smooth muscle tumors of the uterus found in about 20% of women in their thirties and in about 50% of all of women at age 50. Fibroids can cause pain, pressure, abnormal uterine bleeding, recurrent miscarriage and infertility. Preoperative evaluation includes an x-ray procedure called hysterosalpingogram (tubal x-rays), saline infusion sonography (SIS) or MRI scan. Preoperatively your physician may recommend treatment to shrink the fibroid with gonadotropin-releasing hormone (GNRH) such as Lupron or Synarel. The decrease in the size of the fibroid may facilitate the outpatient laparoscopic resection of the fibroid avoiding major surgery. During the procedure you may expect to have a belly button incision measuring about 1/2inch and two additional ¼ inch incisions in the lower abdomen. The uterus is injected with a solution which causes the blood vessels feeding the fibroid to shrink, therefore minimizing blood loss during the surgery. Utilizing a CO2 laser or electric cautery knife, the surgeon will make an incision in the uterus to expose and remove the fibroid. The uterine incision is then closed with sutures applied to the uterus via the camera guided laparoscope. The fibroid is then removed from the abdomen utilizing a power tool which cuts the fibroid into smaller segments. These smaller segments can then be removed from the abdomen through the tiny incisions in the lower abdomen. The incision in the uterus is then covered with a special material (Intercede) which serves as a barrier to the formation of scar tissue during the healing phase following the surgery. The three small incisions in the abdomen are then covered with a Band-Aid and the patient is discharged home several hours after the surgery. Expect approximately 2-7 days of recuperation following the surgery.
After the surgery, medical suppression of the endometriosis may be necessary, especially if no pregnancy is immediately planned. Medical treatment include gonadotropin releasing hormone (GnRH) such as Lupron or Synarel (chemical menopause), or suppression of ovulation with continuous oral contraceptive therapy. Sometimes when long-term therapy is necessary with GnRH, estrogen or progesterone such as norethindrone are added to minimize the risk of significant bone loss. |
| Laparoscopic CO2 laser tubal surgery |
| When in the process of infertility evaluation, the fallopian tubes are found to be blocked at the end (hydrosalpinx) or involved in scar tissue (adhesions), laparoscopic surgery is often performed to remove the scar tissue and open up the fallopian tubes. The surgery is most successful when mild scar tissue is noted.
Pregnancy rates after opening the end of the tube range between 15 and 25% within 18-24 months following the surgery. For this reason, when severe scar tissue or when hydrosalpinx are noted, in vitro fertilization (IVF) is often recommended. |
| Laparoscopic treatment of tubal pregnancy |
| »CLICK TO VIEW TUBAL PREGNANCY SURGERY |
Tubal pregnancy (ectopic) occurs when the fertilized egg implants within the walls of the fallopian tube. When the tubal pregnancy is diagnosed early, it can be treated by laparoscopy before severe tubal damage or bleeding occurs. Risk factors for tubal pregnancy include previous tubal surgery, previous tubal pregnancy, history of pelvic infection or history of endometriosis. If the tubal pregnancy has not ruptured, a small incision is made in the wall of the fallopian tube through which the pregnancy can be gently removed. When the pregnancy is implanted at the site where the tube attaches to the uterus (interstitial, cornual), resection of the tube with a portion of the uterine "horn" may be necessary. In situations where the tube is severely damaged, it may be necessary to remove the entire tube (salpingectomy).
The major complications from laparoscopic surgery for ectopic pregnancy include bleeding which may result in the removal of the fallopian tube. Another complication is the persistence of pregnancy tissue within the fallopian tube which may result in recurrence of bleeding. For this reason a patient undergoing laparoscopic treatment for ectopic pregnancy needs to be monitored with a blood test for beta HCG levels until it becomes negative to make sure that the pregnancy has completely resolved. If the blood tests for the beta HCG level indicate that pregnancy tissue may be still present within the wall of the fallopian tube, chemotherapy (methotrexate) may be necessary. |
Small incision.
Outpatient surgery.
Lower risk of scar tissue formation.
Faster recuperation as compared with traditional surgery. Generally speaking most patients can be expected to fully recover and to be back to work in about seven days.
Lower-cost.
Less postoperative pain. |
| After the surgery is over, you will be moved to a stretcher and transferred to the recovery room where you will be waking up from the anesthesia. A nurse will be there carefully monitoring your recovery and will attend to all of your needs. You may receive pain medication in the recovery room and you will be discharged after approximately one or two hour of recuperation. At the conclusion of the surgery, your physician may have injected local anesthetic into the incisions to minimize postoperative pain. Following surgery expect to recover at home for at least two days before resuming normal activities. You may, however, experience abdominal discomfort for about a week after the surgery. Pain medication and antibiotics may be prescribed by your physician. You will be scheduled for postoperative consultation to make sure your incisions healed properly and to go over the operative findings and therapeutic recommendations. Generally, absorbable sutures are utilized to close the small incisions in the abdomen so no sutures need to be removed. Severe pain, fever, bleeding from the incision, severe nausea or vomiting may be signs of serious complications and you should inform your physician immediately of any such complaints. |
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