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OPERATIVE
LAPAROSCOPY |
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What is Operative Laparoscopy?
Many infertility disorders can be safely treated through
the Laparoscope at the same sitting. When Laparoscopy is
used for looking and diagnosing only, it is called Diagnostic
Laparoscopy.
In most cases, we are able to perform surgical procedures
through the Laparoscope. In this case, we call it Operative
Laparoscopy. It often requires more small cuts above the
pubic bone(usually two or three). It also requires a series
of specialized instruments like graspers, biopsy forceps,
scissors, coagulators, electrosurgical or laser instruments
needle holders and suture materials which are inserted through
these small cuts. With Operative Laparoscopy, there are
no major incisions, and the abdomen is not opened. Because
of this, the patient can frequently go home the same day
after surgery. This greatly reduces the cost of the surgery,
and allows you to return to work and to your normal activities
sooner. The amount of pain involved is also much less.
What is the purpose of this Operative Laparoscopy?
Many of the problems that affect fertility can be treated
through the laparoscope. One of the most common is scar tissue
formation(adhesions) around the tubes, ovaries, or uterus,
which can interfere with the woman's ability to become pregnant.
The scar tissue may be the consequence of previous infection,
endometriosis, or prior surgery. The scar tissue is cut and
removed (adhesiolysis) through the laparoscope, freeing the
pelvic organs.
Operative Llaparoscopy can also be used to treat Endometriosis.
Endometriosis is a very common disease that affects women,
and often causes pain, infertility, and scarring of the pelvis.
Through the Operative Laparoscope, the Endometriosis can be
destroyed (fulgurated) and scar tissue can be removed. Occasionally,
large endometriotic cysts form in the ovary (endometriomas
or chocolate cysts). These can also be treated through the
Laparoscope.
Many infertile women have problems with their tubes. They
may even have had previous surgery on the tubes. Repeat major
surgery on the damaged tubes is usually not very successful.
In this case, one can attempt to reopen the tubes by Operative
Laparoscopy. A number of other procedures can also be accomplished
through the Laparoscope
As an operative procedure, Laparoscopy is also used for female
sterilization (tubal ligation), some vaginal hysterectomies,
and to collect eggs for in vitro fertilization. It also is
a useful technique for taking a biopsy, aspirating a cyst,
or locating and removing an intrauterine device(IUD) that
has perforated the uterus. Laparoscopy can be used as an alternative
to open surgery for some nongynecologic operations, such as
removal of the appendix, gallstones, or gallbladder.
Ectopic(tubal) pregnancies can often be treated by Operative
Laparoscopy. Either the whole tube can be removed, or just
the part with the ectopic can be conservatively treated.
Other procedures that can be accomplished by Laparoscopy
- Diagnosis of pelvic pain
- Evaluation and treatment of infertility
- Tubal reconstruction
- Treatment of poly cystic ovaries(PCO Drilling)
- Removal of diseased ovaries
- Pelvic abscesses
- Removal of uterine fibroids (Myomectomy)
- Hysterectomy
- Correction of genital prolapse
- Chronic pain procedures
- Uterosacral nerve ablation
- Prescaral Neurectomy
- GIFT Procedure
- Bladder neck surgery
What Surgical Procedures Can Not be Performed by Operative
Laparoscopy?
Not every gynecologic surgery can be performed with the Operative
Laparoscope. In some cases, scar tissue may be very thick
or attached to vital organs, and it is not possible to perform
Laparoscopic surgery. This is particularly true if there is
a lot of the scar tissue or endometriosis close to the bowel
or a major blood vessel. Tubal reversal (reconnecting tubes
after a tubal ligation) is not generally done through the
Laparoscope at this time. Finally, we will not perform any
procedure through the Laparoscope that may place you at an
unnecessary risk.
The Advantages of Operative Laparoscopy
- Small punctures instead of one long incision
- Reduced post-operative pain
- Shortened hospital stay
- Shortened convalescence
- Reduced risk of adhesions
- Reduced risk of infection
To the patient the most significant improvement is the marked
reduction in the size of the incisions. Small punctures of
5 or 10 mm, usually 3 to 4 in number, result in much less
pain than the standard laparotomy incisions of 6 to 10 cm.
Healing tends to be rapid resulting in early mobilisation,
a shorter hospital stay and more importantly an early return
to work. The cosmetic value is also important to many patients
who do not wish to have long, obvious scars. Of greater importance
are the benefits of reduced risk of infection and adhesion
formation. Laparoscopic surgery is by nature a closed operation
and hence reduces the risk of contamination. The moist conditions
maintained in the abdomen also reduce the risk of adhesion
formation, which can cause pain.
How do I prepare for Diagnostic Laparoscopy?
2 days prior to the procedure
- Soft diet/
liquid diet
- Tab Dulcolax
2 at night
- Tab Dimol
2 at night
The
day prior to the proceduree
- Liquids
only
Liquids
may include fruit juices, soups etc.
No milk
and milk products
No milk
and milk products
- Tab Perinorm
twice a day
- Peglac
Powder
1 Packet
+ Flavour dissolved in 2 litres of waterr
To consume
the prepared liquid (approx. 250 ml every 15 mins) between
5 pm and 7 pm
- Patient
may consume clear liquids upto 10 pm
- Fasting
from 10 pm onwards
Morning of the
surgery
- Nothing to be taken by mouth
- Private parts are to be shaved
The type of anaesthesia and basic procedure are the same as
for a Diagnostic Laparoscopy.
Duration of Laparoscopic Surgery
Operative Laparoscopy can last from 1-3 hours, depending on
the complexity of the procedures that are required. On rare
occasions, an Operative Laparoscopy is converted to a Laparotomy
in order to complete the excision or repair.
What are the risks associated with Operative Laparoscopy?
Rarely, women (one woman of every 100 to 600) undergoing this
procedure will develop a complication.
- The most common complication is bleeding inside the
pelvis during the surgery.
- Damage to the bowel, the bladder, or other vital organs
inside the abdomen can also occur, since many patients
have a significant amount of scar tissue around these
organs. If damage to bowel, bladder or a major blood vessel
were to occur, you would require an immediate laparotomy
(major incision and surgery) for repair. Sometimes, the
injury to the organs or bladder is not noticed until a
few days after Operative Laparoscopy.
- Rarely, large hematomas (blood clots) of the abdominal
wall can occur near the areas where the small incisions
were created.
- Infection can also occur, particularly when dye is injected
into the tubes to test whether they are open. The dye,
because it is injected through the cervix and vagina,
can carry bacteria into the tubes and thus cause an infection.
- Allergic reactions to medications can also arise, and
this is unpredictable.
Certain conditions may increase the risk of serious complications.
These include previous abdominal surgery, presence of
bowel or pelvic adhesions, severe endometriosis, obesity
or excessive thinness.
When we do Operative Laparoscopy, there is a small chance
that we may have to do major surgery in order to repair the
bowel or bladder, or to stop any bleeding. This is a risk
that has to be accepted before we can undertake any Operative
Laparoscopy procedure. Nevertheless, this has been extremely
rare in our experience.
Considering Operative Laparoscopy Versus Laparotomy
of Pelvic Surgery
Many gynecologic, reproductive, or tubal operations have been
performed using "major" surgery (Laparotomy). Laparotomies
are generally performed through a "bikini" or through
an "up and down" skin incision. Patients generally
remain in the hospital between two and five days following
surgery and may return to work in four to six weeks, depending
on the level of physical activity required.
More recently many of these surgeries can be performed using
the Laparoscope (Operative Laparoscopy). Although the same
type of procedure are performed by Laparotomy, Operative Laparoscopy
uses much smaller skin incisions, generally three to four,
approximately one quarter to one-half inch wide. Following
Operative Laparoscopy, patients are generally able to return
home the day of surgery and recover more quickly, returning
to full activities in three to seven days.
Notwithstanding the advantages of Operative Laparoscopy, not
all procedure can be performed with this technique. Some types
of surgeries may be too risky to perform Laparoscopically,
while in others it is not clear that Laparoscopy yields results
as good as those by Laparotomy. When considering a pelvic
or reproductive operation, you should discuss with the doctor
the pros and cons of performing a Laparotomy verses an Operative
Laparoscopy, the surgical results and the overall risks.
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