essentially means the visualization of the abdominal organs through
a tubular instrument introduced into the abdomen through a 1cm
opening near the umbilicus.
CCD camera is attached to the outer end of the laparoscope.
The uterus, ovary and the rest of the pelvic and abdominal
organs can be visualized through the scope and viewed on a
television monitor. Instruments
passed through two tiny 5mm holes lower down in the abdomen can
rectify any defects in the visualized organs . . It is usually
combined with hysteroscopy.
visualizes the interior of the uterus and any polyps or adhesions
can be removed.
the infertile woman: Laparoscopy
as a primary modality for diagnosis of the infertile woman is no
more practiced. Laparoscopy
may be resorted to in the following situations
Laparoscopic drilling of ovaries
In women who fail to ovulate because of a condition called
polycystic ovarian syndrome, if oral medications fail to achieve
ovulation, laparoscopic drilling of the ovaries may be done. In polycystic ovaries, the ovaries are fully of tiny
follicles with fluid in it. A few of these fluid filled follicles are punctured using an
instrument introduced through the laparoscope. This causes reduced levels of hormones called androgens and
subsequently there is restoration of normal ovulation. In
the adjacent picture, the white organ is the ovary. the few
brown spots seen on it are made by the electrocautery .
What to expect after this
Will my PCOD be totally
cured? In 82% of
patients, ovulation can be expected.
In 63% , conception can be expected either spontaneously or
after treatment with medications to which they were previously
resistant. It is cheaper compared to treatment with
hormone injections. The effect may last longer.
The rate of miscarriage in PCOD patients who concieve with
laparoscopic drilling is slightly lower than that of women with
PCOD who concieve with medical treatment. for those who
respond to laparoscopic drilling, but relapse into anovulation,
a repeat procedure has been shown to be effective . This
procedure is particularly useful for slim women with PCOD.
If a woman fails to conceive inspite of medical treatment, it
may be prudent to check and see if the fallopian tubes are patent.
This can be achieved by injecting fluid into the uterus
through a cannula introduced through the vagina. The fluid traverses the uterus , the fallopian tubes and then
comes into the abdomen through the opening of the tubes called the
fimbrial end. The
fimbrial ends are visualized on the laparoscopy monitor . Any blocks
near the fimbrial end or any adhesions near any part of the tube can
be removed through laparoscopic instruments. If there is a block near the uterie end of the tube it can be
rectified through hysteroscopic cannulation.
In some women, there may be severe abdominal cramps near the
time of menstrual periods. This
could be due to a disease called endometriosis. On examination of the vagina, the doctor may find some
nodularities in the vagina. Endometriosis
could cause infertility in many ways and the best way to correct it
is through the laparoscope. Laparoscopic
correction of endometriosis yields very high pregnancy rates.
Adhesions between the uterus and ovaries could cause
infertility and these could be corrected through the laparoscope
In the adjacent picture, there are adhesions between the ovary(The
white organ) and the uterus (the pink organ) caused by
endometriosis. The release of the adhesions with an instrument
has resulted in some amount of bleeding , seen in the picture.
What it involves
for the patient: The procedure is usually done under General
anaesthesia. The patient’s basic blood investigations are done and
she is given a laxative the previous night. Patients staying in the
same district as the hospital are admitted on the same day of the
surgery. The patient
has to be nil by mouth on the day of the procedure.
procedure she is kept in the recovery room for about 3-4 hours and
then taken to her room. Usually
the patient is discharged on the next day in our centre.