What is Operative Laparoscopy?
Many infertility disorders can be safely treated through the Laparoscope at the same sitting. When Laparoscopy is used for looking and diagnosing only, it is called Diagnostic Laparoscopy.
In most cases, we are able to perform surgical procedures through the Laparoscope. In this case, we call it Operative Laparoscopy. It often requires more small cuts above the pubic bone(usually two or three). It also requires a series of specialized instruments like graspers, biopsy forceps, scissors, coagulators, electrosurgical or laser instruments needle holders and suture materials which are inserted through these small cuts. With Operative Laparoscopy, there are no major incisions, and the abdomen is not opened. Because of this, the patient can frequently go home the same day after surgery. This greatly reduces the cost of the surgery, and allows you to return to work and to your normal activities sooner. The amount of pain involved is also much less.
What is the purpose of this Operative Laparoscopy?
Many of the problems that affect fertility can be treated through the laparoscope. One of the most common is scar tissue formation(adhesions) around the tubes, ovaries, or uterus, which can interfere with the woman’s ability to become pregnant. The scar tissue may be the consequence of previous infection, endometriosis, or prior surgery. The scar tissue is cut and removed (adhesiolysis) through the laparoscope, freeing the pelvic organs.
Operative Laparoscopy can also be used to treat Endometriosis. Endometriosis is a very common disease that affects women, and often causes pain, infertility, and scarring of the pelvis. Through the Operative Laparoscope, the Endometriosis can be destroyed (fulgurated) and scar tissue can be removed. Occasionally, large endometriotic cysts form in the ovary (endometriomas or chocolate cysts). These can also be treated through the Laparoscope.
Many infertile women have problems with their tubes. They may even have had previous surgery on the tubes. Repeat major surgery on the damaged tubes is usually not very successful. In this case, one can attempt to reopen the tubes by Operative Laparoscopy. A number of other procedures can also be accomplished through the Laparoscope.
As an operative procedure, Laparoscopy is also used for female sterilization (tubal ligation), some vaginal hysterectomies, and to collect eggs for in vitro fertilization. It also is a useful technique for taking a biopsy, aspirating a cyst, or locating and removing an intrauterine device(IUD) that has perforated the uterus. Laparoscopy can be used as an alternative to open surgery for some nongynecologic operations, such as removal of the appendix, gallstones, or gallbladder.
Ectopic(tubal) pregnancies can often be treated by Operative Laparoscopy. Either the whole tube can be removed, or just the part with the ectopic can be conservatively treated.
Other procedures that can be accomplished by Laparoscopy
- Diagnosis of pelvic pain
- Evaluation and treatment of infertility
- Tubal reconstruction
- Treatment of poly cystic ovaries(PCO Drilling)
- Removal of diseased ovaries
- Pelvic abscesses
- Removal of uterine fibroids (Myomectomy)
- Hysterectomy Correction of genital prolapse
- Chronic pain procedures
- Uterosacral nerve ablation
- Prescaral Neurectomy
- GIFT Procedure
- Bladder neck surgery
What Surgical Procedures Can Not be Performed by Operative Laparoscopy?
Not every gynecologic surgery can be performed with the Operative Laparoscope. In some cases, scar tissue may be very thick or attached to vital organs, and it is not possible to perform Laparoscopic surgery. This is particularly true if there is a lot of the scar tissue or endometriosis close to the bowel or a major blood vessel. Tubal reversal (reconnecting tubes after a tubal ligation) is not generally done through the Laparoscope at this time. Finally, we will not perform any procedure through the Laparoscope that may place you at an unnecessary risk.
The Advantages of Operative Laparoscopy
- Small punctures instead of one long incision
- Reduced post-operative pain
- Shortened hospital stay
- Shortened convalescence
- Reduced risk of adhesions
- Reduced risk of infection
To the patient the most significant improvement is the marked reduction in the size of the incisions. Small punctures of 5 or 10 mm, usually 3 to 4 in number, result in much less pain than the standard laparotomy incisions of 6 to 10 cm. Healing tends to be rapid resulting in early mobilisation, a shorter hospital stay and more importantly an early return to work. The cosmetic value is also important to many patients who do not wish to have long, obvious scars. Of greater importance are the benefits of reduced risk of infection and adhesion formation. Laparoscopic surgery is by nature a closed operation and hence reduces the risk of contamination. The moist conditions maintained in the abdomen also reduce the risk of adhesion formation, which can cause pain.
How do I prepare for Diagnostic Laparoscopy?
2 days prior to the procedure
- Soft diet/ liquid diet
- Tab Dulcolax 2 at night
- Tab Dimol 2 at night
The day prior to the proceduree
- Liquids only
- Liquids may include fruit juices, soups etc.
- No milk and milk products
- No milk and milk products
- Tab Perinorm twice a day
- Peglac Powder
- 1 Packet + Flavour dissolved in 2 litres of water
- To consume the prepared liquid (approx. 250 ml every 15 mins) between 5 pm and 7 pm
- Patient may consume clear liquids upto 10 pm
- Fasting from 10 pm onwards
Morning of the surgery
- Nothing to be taken by mouth
- Private parts are to be shaved
The type of anaesthesia and basic procedure are the same as for a Diagnostic Laparoscopy
Duration of Laparoscopic Surgery
Operative Laparoscopycan last from 1-3 hours, depending on the complexity of the procedures that are required. On rare occasions, an Operative Laparoscopy is converted to a Laparotomy in order to complete the excision or repair.
What are the risks associated with Operative Laparoscopy?
Rarely, women (one woman of every 100 to 600) undergoing this procedure will develop a complication.
- The most common complication is bleeding inside the pelvis during the surgery.
- Damage to the bowel, the bladder, or other vital organs inside the abdomen can also occur, since many patients have a significant amount of scar tissue around these organs. If damage to bowel, bladder or a major blood vessel were to occur, you would require an immediate laparotomy (major incision and surgery) for repair. Sometimes, the injury to the organs or bladder is not noticed until a few days after Operative Laparoscopy.
- Rarely, large hematomas (blood clots) of the abdominal wall can occur near the areas where the small incisions were created.
- Infection can also occur, particularly when dye is injected into the tubes to test whether they are open. The dye, because it is injected through the cervix and vagina, can carry bacteria into the tubes and thus cause an infection.
- Allergic reactions to medications can also arise, and this is unpredictable. Certain conditions may increase the risk of serious complications. These include previous abdominal surgery, presence of bowel or pelvic adhesions, severe endometriosis, obesity or excessive thinness.
When we do Operative Laparoscopy, there is a small chance that we may have to do major surgery in order to repair the bowel or bladder, or to stop any bleeding. This is a risk that has to be accepted before we can undertake any Operative Laparoscopy procedure. Nevertheless, this has been extremely rare in our experience.
Considering Operative Laparoscopy Versus Laparotomy of Pelvic Surgery
Many gynecologic, reproductive, or tubal operations have been performed using “major” surgery (Laparotomy). Laparotomies are generally performed through a “bikini” or through an “up and down” skin incision. Patients generally remain in the hospital between two and five days following surgery and may return to work in four to six weeks, depending on the level of physical activity required.
More recently many of these surgeries can be performed using the Laparoscope (Operative Laparoscopy). Although the same type of procedure are performed by Laparotomy, Operative Laparoscopy uses much smaller skin incisions, generally three to four, approximately one quarter to one-half inch wide. Following Operative Laparoscopy, patients are generally able to return home the day of surgery and recover more quickly, returning to full activities in three to seven days.
Notwithstanding the advantages of Operative Laparoscopy, not all procedure can be performed with this technique. Some types of surgeries may be too risky to perform Laparoscopically, while in others it is not clear that Laparoscopy yields results as good as those by Laparotomy. When considering a pelvic or reproductive operation, you should discuss with the doctor the pros and cons of performing a Laparotomy verses an Operative Laparoscopy, the surgical results and the overall risks.