Dr Natalie Burger - What is laparoscopy and when is it done?
Minimally Invasive and Robotic Surgical Treatments for Infertility
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Laparoscopic Fertility Surgery
A laparoscopy is an outpatient procedure which is
commonly performed by gynecologists and infertility
specialists. During this outpatient procedure, 2-3
small incisions are made in the belly button and in
the lower abdomen. The belly is then inflated with
carbon dioxide in order to allow the abdominal and
pelvic organs to separate from each other, creating
a space in which the surgeon can work. An operative
telescope (laparoscope) is then inserted through the
belly button incision to allow the surgeon to view
the pelvic cavity, including the uterus, fallopian
tubes, ovaries, and surrounding tissues.
If there is evidence of endometriosis, laser
therapy can be used to treat the disease. Cysts can
also be removed from the ovaries during laparoscopy.
If there is evidence of scar tissue, this can be
treated or removed as well. The patency ('open-ness')
of the fallopian tubes can also be established
during laparoscopy by injecting dye into the uterus
and watching for spillage from the ends of the
fallopian tubes.
Most laparoscopic procedures take between 1-2
hours to complete. Following surgery, a patient
needs a few hours of recovery before being
discharged home with pain medications. It is
recommend to take a few days off after surgery for
full recovery before returning to your normal
activities. More extensive procedures may require a
longer recovery.
Hysteroscopy for Infertility
A hysteroscopy is similar to a laparoscopy in
that a thin camera is used. However, during a
hysteroscopy, the camera is placed through the
vaginal opening into the uterus without making any
incisions. A small amount of fluid is placed in the
uterus to allow the surgeon to adequately visualize
the uterine cavity. At this time, if fibroids,
polyps, or scar tissue is present, they may be
removed. A uterine septum (an abnormal band of
tissue that extends from the top of the cavity into
the lower part of the uterus) can also be removed
during a hysteroscopy.
Following surgery, a patient will spend a few hours
in the recovery area before discharge. Typically, a
patient will make a full recovery within 24-48
hours.
Laparotomy, Traditional Surgery
A laparotomy refers to a surgery where a larger
abdominal incision is made. This is often required
if there are multiple fibroid tumors within the
uterus or if endometriosis or adhesions (scar
tissue) is so severe that treatment cannot be safely
performed through the laparoscope. The incision is
typically made in the area of the 'bikini-line'.
Care is taken to make the incision as small as
possible while still allowing for the surgery to be
safely performed.
Following surgery, patients will often require a
short (1-2 day) hospital stay, though sometimes they
are able to be discharged the day of surgery.
Patients will usually require narcotic medication
for pain relief following a laparotomy. You may
usually return to work within 1-2 weeks following
the performance of a laparotomy.
