Laparoscopy can help physicians diagnose many gynecological problems, including endometriosis, uterine fibroids and other structural abnormalities, ovarian cysts, adhesions (scar tissue) and ectopic pregnancy. Many infertile patients require laparoscopy for a complete evaluation. Generally, the procedure is performed following basic infertility tests, although the presence of pain, a history of infection or other problems may hasten the recommendation of a diagnostic laparoscopy.
The procedure is usually performed soon after menstruation in case a hysteroscopy is also necessary. The uterine cavity is more easily evaluated immediately after menstruation, and there is little risk of interrupting a pregnancy.
After the medical history and physical examination are completed, laparoscopy is usually performed on an outpatient basis, under general anesthesia and with minimal discomfort. After the patient is under general anesthesia, a needle is inserted through the navel and the abdomen is filled with carbon dioxide gas. The gas pushes the internal organs away from the abdominal wall so that the laparoscope can be placed safely into the abdominal cavity to avoid injury to surrounding organs such as the bowel, bladder and blood vessels. The laparoscope, a long, thin, lighted telescope-like instrument, is inserted through an incision in the navel.
While looking through the laparoscope, the physician can see the reproductive organs including the uterus, fallopian tubes and ovaries. A small probe is usually inserted through another one or two incisions above the pubic region in order to move the pelvic organs into clear view. Additionally, a blue solution is often injected through the cervix, uterus and fallopian tubes to determine if they are open. If no abnormalities are noted, one or two stitches close the incisions. If defects or abnormalities are discovered, diagnostic laparoscopy can become operative laparoscopy.
During operative laparoscopy, many abdominal disorders can be safely treated through the laparoscope at the same time that the diagnosis is made. When performing operative laparoscopy, the physician inserts additional instruments such as probes, scissors, grasping instruments, biopsy forceps, electrosurgical or laser instruments, and suture materials through two or three incisions in the area above the pubic bone.
Some problems that can be corrected with operative laparoscopy include removing adhesions from around the fallopian tubes and ovaries, opening blocked tubes, removing ovarian cysts, and treating ectopic pregnancy. Endometriosis can also be removed from the outside of the uterus, ovaries, or peritoneum. Under certain circumstances, fibroids on the uterus can also be removed.
Serious complications of diagnostic and operative laparoscopy are rare. The major risk is damage to the bowel, bladder, ureters, major blood vessels or other organs, which would require emergency surgery to repair. The chance that emergency surgery will be required is two to four per 1,000 procedures. Injuries can occur during the insertion of various instruments through the abdominal wall or during operative treatment. Certain conditions may increase the risk of serious complications. These include previous abdominal surgery, especially bowel surgery and a history or presence of bowel/pelvic adhesions, severe endometriosis, pelvic infections, obesity or excessive thinness.