Fertility Enhancing Gynecological Endoscopy

Endoscopy is simple operation which allows the surgeon to look inside the human body using an instrument called endoscope. Operative tools can be attached to the end of the endoscope, and the apparatus can then be used to perform surgery. Attaching the endoscope to a Camera, which then projects the image on to a TV screen, allows for greater magnification and clearer vision. This type of surgery is called Keyhole Surgery, and leaves only a tiny scar externally. The scope of this surgery ranges from diagnostic to therapeutic procedures and even complex surgeries. From the fertility point of view, Laparoscopy and Hysteroscopy are the two endoscopic techniques commonly deployed. They are   usually performed on a daycare basis, which means that the patient can go home a few hours after surgery.

• Do I need laparoscopy / hysteroscopy?

A hysterolaparscopy is a diagnostic modality in the evaluation of an infertile woman. It permits a direct magnified visual assessment of the uterus, fallopian tubes, ovaries and lower pelvis. It is particularly useful in diagnosing endometriosis, tubal disorders or pelvic adhesions and generally is performed at the end of a work-up, but may be performed earlier if deemed appropriate by your history and referral diagnosis

• How are endoscopic surgeries performed?

Endoscopic surgeries are usually performed on a daycare basis under general anesthesia. During hysteroscopy, mouth of the uterus (cervix) is dilated and the hysteroscope is gently introduced into the uterine cavity to inspect it from within. Skin incisions are not required for hysteroscopy.

In laparoscopy, a needle is inserted through the naval and the abdomen is filled with carbon dioxide gas. The gas pushed the abdominal wall away from the internal organs allowing the laparoscope to be placed safely into the abdominal cavity. While looking through the laparoscope, the surgeon visualizes the reproductive organs including the uterus, fallopian tubes and ovaries. One or more small probes are usually inserted through other incisions in order to manipulate the pelvic organs into clearer vision. A solution containing Methylene blue, a dye, is then injected through the cervix, uterus and fallopian tubes to determine if the tubes are open. If no abnormalities are noted at this time, the endoscope and the probes are withdrawn and the skin incisions are closed with one or two stitches.

• When is operative laparoscopy / hysteroscopy indicated?

During operative laparoscopy, many abdominal disorders can be treated safely through the laparoscope at the same time the diagnosis is made. When performing operative laparoscopy, the surgeon insets additional instruments such as probes, scissors, grasping instruments through two or three additional incisions. The common indications for operative laparoscopy are ectopic pregnancies, ovarian cysts, endometriosis and dermoid cysts, fibroids etc.

Operative hysteroscopy is indicated commonly for treatment of adhesions, uterine cavity abnormalities, submucosal polyps and fibroids.

• When should one plan a diagnostic laparoscopy + hysteroscopy?

Hysterolaparscopy is usually done in the week after the end of periods to prevent the possibility of disturbing a pregnancy (as can happen if done in the second half of the menstrual cycle).

• How long does it take to do an endoscopic surgery?

A diagnostic hysterolaparscopy usually takes no more than 40 minutes. If any abnormality is found and has to be created in the same sitting, the surgery takes longer depending on the type of abnormality.

• What self-care is necessary after returning home?

You should leave the adhesive bandage or dressing on the incision for five days. During that period, it is important to keep the incision area dry. Complete bed rest is not necessary, but you should avoid any vigorous activity and lifting weights.

• When can I go back to work after the surgery?

Most women feel well enough to return to work or normal daily activities two to three days after a diagnostic endoscopy. If any surgical procedure is carried out, a week’s rest may be advisable.

• What are the risks associated with endoscopic surgeries?

Some women may feel weak and experience abdominal cramps for a day or so. Spotting and light bleeding can occur for several days afterwards. Complications are rare and seldom serious. These includes bleeding infection, perforation of uterus/bladder/bowel or allergic reaction to the general anesthetic.