Advanced Laparoscopy

Diagnostic Laparoscopy

Laparoscopy is a minor surgical procedure performed on an outpatient basis, usually under general anesthesia. The physician inserts a laparoscope (a narrow, lighted telescope) through a small incision within or just below the navel to view the uterus, fallopian tubes and ovaries. One or two small probes are usually inserted through another incision above the pubic region and/or lower part of the abdominal wall to view the pelvic organs. Additionally, dye is inserted through the cervix to determine tubal patency. If the physician does not detect abnormalities, one or two stitches are used to close the incisions. If abnormalities are identified, the Diagnostic Laparoscopy can turn into an Operative Laparoscopy with additional small incisions and other instruments to treat lesions that are found. The procedure is used to diagnose:

  • Endometriosis – a disease in which tissue resembling endometrium, the lining of the uterus, grows outside the uterus
  • Uterine fibroids and other abnormalities
  • Ovarian cysts
  • Adhesions (scar tissue)

Laparoscopy is generally recommended for women with:

  • Symptoms of endometriosis, including pelvic pain, increasingly painful periods, pain with and/or after intercourse, lower abdominal pain, infertility, growths on the ovary (adnexal mass)
  • History, physical findings or HSG results that suggest tubal disease that may be repairable
  • In occasional cases, treatment for polycystic ovarian disease by ovarian drilling
  • For evaluation and treatment of pelvic masses

Operative Laparoscopy

If defects and abnormalities are discovered during a diagnostic laparoscopy, the procedure can become an operative laparoscopy. During an operative laparoscopy, the physician inserts additional instruments such as probes, scissors, grasping instruments, biopsy forceps, electrosurgical or laser instruments through two or three additional incisions. The technique and instruments used by the physician depend on his/her experience, the location of the problem and the availability of the equipment. The procedure may be used to:

  • Remove adhesions from around fallopian tubes and ovaries
  • Open blocked tubes
  • Remove ovarian cysts
  • Remove uterine fibroids
  • Remove endometriosis from the outside of the uterus, ovaries or peritoneum, bowel and/or bladder
  • Remove diseased ovaries

The most common risk associated with laparoscopy is postoperative bladder infection. Uncommon risks include adhesions, hematomas of the abdominal wall near the incision and pelvic or abdominal infections. Rare, but important risks to note include bleeding, damage to other organs or anesthetic complications.