Laparoscopic / Hysteroscopic Surgery (Keyhole Surgery)
Laparoscopic surgery, also called minimally invasive surgery or keyhole surgery, is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5–1.0 cm) as opposed to the larger incisions needed in open surgery.
Laparoscopic surgery includes operations within the abdominal or pelvic cavities.
A laparoscope (telescope) is inserted into the abdomen via a small incision made in the umbilicus. Other instruments can then be inserted through additional small incisions (usually 2 or 3 incisions) so that surgery can be performed under laparoscope visualisation. Keyhole surgery makes use of images displayed on TV monitors to magnify the surgical elements.
“Most surgical infertility treatment can now be carried out by laparoscopic or hysteroscopic surgery.”
The surgeon will visually evaluate the pelvic organs and surrounding abdominal organs. He will look for the presence of cysts, fibroids, scar tissue or adhesions, and endometrial growths. He will also look at the shape, color, and size of the reproductive organs. A dye may be injected through the cervix, so the surgeon can evaluate if the fallopian tubes are open.
Even if no signs of endometriosis or other problems are found, the surgeon may remove a sample of tissue to be tested. Sometimes, very mild endometriosis is microscopic and cannot be seen by the naked eye with the laparoscopic camera.
During laparoscopic surgery, you’ll be under the effects of general anesthesia, so you should not feel any pain, nor remember the procedure. When you wake up, you may have a sore throat, feel sore around the cuts, and your abdomen may feel tender. You may feel bloated and you may experience sharp pains in your shoulder. This is normal and should go away within a few days.
Though you will probably go home on the same day, you should plan on taking it easy for two days. You may need a week to recover. You might be prescribed pain medication and antibiotics. There are a number of advantages to the patient with laparoscopic surgery versus an open procedure.
- Reduced hemorrhaging, which reduces the chance of needing a blood transfusion.
- Smaller incision, which reduces pain and shortens recovery time, as well as resulting in less post-operative scarring.
- Less pain, leading to less pain medication needed.
- Although procedure times are usually slightly longer, hospital stay is less, and usually with a same day discharge which leads to a faster return to everyday living.
Hysteroscopy is a procedure through which your doctor can look inside your uterus in order to diagnose and treat pathologies. A Hysteroscope is a thin, telescope which is inserted through the vagina to examine the cervix and the cavity of the uterus.
You may be advised a Hysteroscopy to correct the following uterine conditions:
- Polyps, fibroids or adenomyosis - These benign (non-cancerous) growths are found in the uterus and can affect fertility.
- Uterine adhesions - These are bands of scar tissue that can form in the uterus and may lead to changes in menstrual flow and affect fertility.
- Septum – This is a congenital malformation of the uterus and can lead to miscarriages.
- Abnormal bleeding - Hysteroscopy can help identify the cause of heavy/prolonged menstrual flow, or bleeding in between periods.
Your doctor may take a small sample of tissue (biopsy) for examination by a Pathologist.
Your doctor will recommend scheduling surgery between Day 6 and Day 10 of your menstrual cycle. This timing will provide the doctor with the best view of the inside of your uterus and decrease the risk of bleeding from the ovaries at laparoscopic surgery.
Hysteroscopy and laparoscopy do not usually require an overnight stay in the hospital. The procedure is performed under general anesthesia and the patient usually goes home a few hours later.
After the procedure, you may have some cramping or slight vaginal bleeding for a few days.
When indicated, a Hysteroscopy is often done at the same time as a Laparoscopy.