Laparoscopy & Hysteroscopy

Laparoscopy and hysteroscopy are procedures recommended during treatment for infertility. These procedures enable the doctor to view the structures and organs inside your pelvis and carry out certain corrective procedures. Laparoscopy is performed to view and access the exterior of the uterus, ovaries, fallopian tubes and other structures within the pelvis. Hysteroscopy is performed to view the internal cavity of the uterus, identify abnormalities and perform certain corrective procedures. These procedures are best performed soon after menstruation when the view would be unobstructed.

Laparoscopy

Your doctor may recommend a laparoscopy if you have pelvic pain or a history of pelvic disease. It helps diagnose and treat conditions such as uterine fibroids, blocked tubes, endometriosis, ectopic pregnancies, ovarian cysts, adhesions and other structural abnormalities. A laparoscopy may be recommended after the initial fertility examination.

How is it performed?

The procedure is usually carried out under general anaesthesia. A telescope-like tube called a laparoscope is inserted into the abdominal cavity through a small incision in the navel or surrounding area. Carbon dioxide gas is then passed into the abdominal cavity which separates the internal organs from the cavity wall. This provides a better view through the laparoscope and can also prevent injuries. A small probe is inserted through a similar incision in your lower abdomen to manipulate the structures being evaluated. Fluid is passed through the cervix, uterus and fallopian tubes to identify any blockages. If a problem is detected, it may be corrected with the help of surgical instruments inserted through 1-2 additional incisions in your lower abdomen. Once the procedure is complete the instruments are removed, the abdomen is deflated and the incisions closed with sutures. Some procedures may not be carried out through the laparoscope and would require an open incision.

What are the risks and complications?

Following laparoscopy, you may experience some pain and bruising at the incision sites. You may also feel some discomfort due to the introduction of gas into the abdomen. Your discomfort varies according to the type and extent of the procedure. You will usually be able to leave the same day and can resume your activities in a few days.

As with any procedure, laparoscopy may be associated with certain risks which include infection, hematomas in the abdominal wall, skin irritation and rarely damage to internal organs and important blood vessels and nerves.

Hysteroscopy

Hysteroscopy is usually recommended to identify the cause of infertility, miscarriage, and abnormal uterine bleeding. It is usually preceded by other imaging studies such as ultrasound. A hysteroscopy can help identify abnormalities within the uterine cavity such as fibroids, polyps, areas of scarring and congenital malformations. Surgery may be performed during hysteroscopy to correct certain abnormalities. Prior to surgery you may be asked to take certain medications to prepare the uterus.

How is the procedure performed?

The procedure is performed outpatient and requires no incisions. The cervical canal is initially widened temporarily with a series of dilators. A thin, long lighted viewing tube called a hysteroscope is then inserted through the cervix to reach the uterus. Saline fluid or carbon dioxide gas is introduced through the hysteroscope to expand the uterine cavity and provide a better view of its internal structure. The hysteroscope has narrow channels through which long surgical instruments are inserted to reach the inside of the uterus and perform surgery. On completion of the procedure a catheter may be left within the uterus. Medications to prevent infection and stimulate healing may be prescribed for some procedures.

Following hysteroscopy, you may experience some cramping, vaginal discharge and bleeding for several days which is normal. You can resume your regular activities in a day or two.

What are the risks associated with hysteroscopy?

Hysteroscopy like other procedures are rarely associated with certain complications which may include perforation of the uterus, bleeding, and damage to surrounding organs. The fluid used to expand the uterus may also cause some complications.

Laparoscopy and hysteroscopy can help diagnose and treat various gynaecological disorders including infertility. The procedures are minimally invasive with fewer complications and less recovery time allowing many procedures to be performed on an outpatient basis. Diagnosis and treatment are often performed during the same procedure thus reducing the number of hospital visits.