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.
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.
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.
Intrauterine adhesions usually from an injury to the
uterine cavity. The most common cause is a D&C
performed for a miscarriage. Much less commonly,
adhesions can result from a severe intrauterine
infection. Intrauterine adhesions can be minor, or
they can affect the entire uterine cavity, possibly
even leading to complete cessation of menstrual
flow. These severe adhesions are called Asherman’s
syndrome.
In order to repair the uterus, a resection of the
intrauterine adhesions is performed
hysteroscopically, sometimes under laparoscopic
guidance. In cases of severe adhesions, it is
preferable to place an intrauterine balloon into the
uterine cavity after the procedure in order to keep
the uterine walls apart as they heal. We typically
leave the balloon in place for two weeks, and place
the woman on relatively high dose estrogen pills
during that time to encourage the uterine lining (endometrium)
to regenerate and cover over the raw surfaces where
the scar tissue used to be. We also ask our patients
to take an antibiotic, commonly tetracycline or a Z
Pack, for the two weeks that the balloon is in place
in order to decrease the risk that any infection
might result from the balloon remaining in the
uterus.
After the balloon has been removed in the office, we
will ask you to continue the estrogen for an
additional 10-14 days, and we will also ask you to
take a progesterone pill for the last 10 days of the
estrogen. When you stop both of those pills, you
will have a menstrual period that may be a little
heavier than a normal period. We will then typically
ask you to have another HSG performed in order to
confirm complete resection of the adhesions.
Although most adhesions can be successfully removed
at hysteroscopy, it may require more than one
procedure to treat severe adhesions.
Fallopian tube reanastomosis is a surgical technique
developed to repair the fallopian tubes after a
sterilization procedure. Sterilization procedures
are usually performed by placing some sort of
occlusive device in the isthmus (mid segment) of the
fallopian tube. The technique to restore the patency
of the fallopian tubes involves resecting the
obstructed portion of each of the fallopian tube
segments and re-attaching those segments
microscopically. This is performed through a very
small abdominal incision utilizing an operating
microscope. Alternatively, the procedure can
occasionally be performed through a laparoscope. If
the tubal occlusive device was a clip or a band or
if a small segment of the tube was simply resected,
the chance of successful anastomosis is higher.
However, if cautery (electric current) was used for
sterilization, the outcome of reanastomosis is much
less successful, probably because the cautery can
affect much more of the fallopian tube than is
damaged with clips or bands. Many of these patients
will need to proceed to in vitro fertilization, as
their pregnancy rate will be higher and their time
to becoming pregnant is much shorter.
