What is Laparoscopy?
Laparoscopy is a minimally invasive “keyhole” procedure that enables a detailed examination of the pelvic organs, including the uterus (womb), ovaries, and fallopian tubes.
Indications:
Laparoscopy is commonly recommended for fertility patients as it provides the most accurate assessment of pelvic organ health in preparation for pregnancy. As part of the procedure, a dye test is performed to ensure the fallopian tubes are open and functioning properly.
Additionally, laparoscopy is offered to women experiencing unexplained pelvic pain and is used to treat conditions such as:
- Ovarian cysts
- Endometriosis
- Various tubal disorders.
How is Laparoscopy Done?
A laparoscopy typically takes between 20 and 40 minutes. The procedure involves inserting a telescopic camera (laparoscope) through a small incision, about 1 cm in size, just below the belly button (umbilicus). Additionally, 2 to 3 smaller incisions (0.5 – 1 cm) are made lower in the abdomen to allow the insertion of surgical instruments for a detailed examination of the pelvic organs. To create space for maneuvering the instruments, the abdominal cavity is inflated with carbon dioxide gas during the procedure.
How Is Laparoscopy Used?
Adhesions
Adhesions are scar-like bands that can cause the ovaries, fallopian tubes, and uterus to stick together. They often result from endometriosis or infections and may lead to pain and subfertility. Laparoscopic surgery can be used to separate adhesions, but they tend to reform. To minimize re-scarring, a special fluid may be left in the abdominal cavity during the procedure.
Treatment of Endometriosis
Endometriosis occurs when the uterine lining (endometrium) travels backward through the fallopian tubes and settles in the pelvic cavity, often around the ovaries and uterus. This can lead to cysts, severe scarring, and distortion of normal reproductive anatomy. Laparoscopy helps restore normal anatomy and allows for the removal of endometriotic cysts.
Ovarian Cysts
Ovarian cysts are usually detected via ultrasound before laparoscopy. If a cyst does not resolve on its own, laparoscopy may be used for closer examination and removal. In most cases, cysts can be removed through keyhole surgery, though in some instances, a larger incision (laparotomy) may be required. The goal is to remove the cyst while preserving the healthy ovary.
Laparoscopic ovarian drilling is another procedure used in patients with polycystic ovary syndrome (PCOS). Small holes are made in the ovaries to stimulate ovulation without the need for medication.
Ectopic Pregnancy
An ectopic pregnancy occurs when an embryo implants outside the uterus, typically in the fallopian tube. Laparoscopic surgery may be necessary to remove the pregnancy or, in some cases, the entire affected fallopian tube.
Tubal Surgery
If the fallopian tubes have been damaged due to infections or endometriosis, laparoscopic surgery may help open them and improve their function. However, open tubes do not always function properly, and there is an increased risk of ectopic pregnancy.
In cases where the tube is blocked and filled with fluid (hydrosalpinx), laparoscopy is recommended to remove it. Hydrosalpinx can negatively affect fertility by releasing toxic fluid into the uterus, reducing the chances of embryo implantation. This procedure is particularly advised before in vitro fertilization (IVF) to enhance success rates.
Laparoscopic Sterilization
Laparoscopy can also be used for permanent contraception by blocking or sealing the fallopian tubes.
Post-Operative Care
At the end of the procedure, most of the gas used to inflate the abdomen is released, but a small amount may remain, causing temporary bloating. In some cases, fluid is left in the abdominal cavity to aid healing and reduce the risk of adhesions, which may also contribute to bloating for a few days.
Some patients experience shoulder-tip pain due to the CO₂ gas irritating the diaphragm and nearby nerves. This discomfort typically lasts one to two days. The small incisions are closed with dissolvable stitches, which usually disappear within two to three weeks.
Advantages of Laparoscopy
- Faster recovery
- Early mobility
- Less pain
- Minimal scarring
- Shorter hospital stay
Risks of Diagnostic Laparoscopy
Although laparoscopy is a routine procedure, all surgeries carry some risks:
- Bleeding & Blood Transfusion – Severe bleeding is rare, occurring in less than 1 in 100 cases. If bleeding cannot be controlled laparoscopically, a larger incision (laparotomy) may be required. Blood transfusion is uncommon but may be necessary in cases of excessive blood loss.
- Infection – Wound infections can occur but are usually minor. Keeping the incision sites clean and following aftercare instructions can reduce this risk.
- Damage to Nearby Organs – The bladder, uterus, fallopian tubes, ovaries, intestines, and ureters (which connect the kidneys to the bladder) are all close together in the surgical area. Though rare, these structures can be injured during surgery. If the bowel is damaged, a leak could cause infection, which may become apparent a few days post-surgery. If you experience persistent pain, fever, chills, or other concerning symptoms after surgery, seek medical attention promptly.
- Blood Clots (Deep Vein Thrombosis & Pulmonary Embolism) – Prolonged immobility during and after surgery increases the risk of blood clots. This risk is generally low for short laparoscopic procedures (45–90 minutes) but may be higher in individuals who smoke, are overweight, or take estrogen-based medications. Staying hydrated and moving as soon as possible after surgery can help prevent clots.
- General Anesthesia Risks – Serious complications from anesthesia are rare, especially in younger women. Allergic reactions can occur but are typically manageable.
- Failed Entry – In rare cases, the surgeon may be unable to safely insert the laparoscopic instruments due to anatomical difficulties. If this happens, the procedure may need to be abandoned or converted to an open surgery with the patient’s consent.
It is essential to receive accurate answers to these crucial questions. To achieve this, it’s important to ask the right questions to your Laparoscopic doctors in Kolkata. Consider consulting Dr. Kriti Agarwal, a highly regarded expert in this field. As a well-qualified Laparoscopic specialist, she has successfully managed numerous cases.
