Keywords hysterectomy abdominal vaginal laparoscopic laparoscopy uterus removal ovary ovaries fallopian tube abnormal bleeding menstruation uterine tumor tumors cancer fibroids leiomyomata endometriosis infection cyst cysts adenomyosis prolapse tissue weakness bladder rectum vagina prolapse pelvic surgery gynecology medical emergency menopause estrogen complications morbidity mortality ectopic pregnancy laser surgery

Over the three decades, laparoscopic surgery has developed as an alternative to open gynecological surgery. It is now possible to convert approximately 95% of gynecological procedures which formerly required an abdominal incision into a relatively minor same day/one day procedure. Dr. Dott has had over 25 years of experience with laparoscopic surgery. He has performed this procedure many times and is certified by the Accreditation Council for Gynecological Endoscopy in Advanced Gynecological Laparoscopy. (http://www.aagl.com/acge1.htm).

He has been taught these procedures in training institutions both in the United States and Russia.

Problems that occur with a woman's reproductive organs sometimes cannot be found by a physical examination alone. Other tests, X-ray, or ultrasound may still leave some uncertainty. In these cases, a type of diagnostic surgery, called laparoscopy, may be performed. It allows the doctor to look inside the abdomen at these organs.

Laparoscopy is done with a slender telescope-like instrument, called a laparoscope, that is inserted through a small cut just below the navel. Although this method does represent surgery that requires anesthesia and involves some discomfort afterward, it is usually safe, and the recovery period is short, usually less than a week..

Laparoscopy is done to help your doctor determine what is wrong. Laparoscopy is also used as a method of sterilization or as a method of treatment, but only diagnostic uses (to identify a disease) are discussed here. If you have any questions about laparoscopy or why you are having it, discuss them with your doctor.

Uses of Diagnostic Laparoscopy

Laparoscopy is often used to find the cause of abdominal pain, infertility, or other problems in the reproductive organs. In these cases, a doctor cannot tell from a physical exam or from a patient's symptoms exactly what is wrong. A look inside the body is needed.

Abdominal Pain

Pain in the lower abdomen can have many causes. If the pain occurs early in pregnancy, a diagnostic laparoscopy may be performed because of the risk of an ectopic pregnancy. In a normal pregnancy the fertilized egg develops in the uterus, but in an ectopic pregnancy, the egg may lodge elsewhere, such as in a tube. As the egg grows, the thin wall of the tube balloons outward and eventually may burst. With laparoscopy, some pregnancies that develop outside the uterus can be diagnosed in time to protect the mother's health and prevent severe damage to the tubes so that future pregnancies are possible.

Sharp, deep pain in the pelvis during intercourse or at other times may be caused by endometriosis. This is a condition in which tissue like the inner lining of the uterus is found growing in other areas in the pelvis. Sometimes this tissue is seen on the surface of the tubes, ovaries, uterus, bowel, or on other parts of the body in the lower abdomen. This tissue bleeds at the end of each menstrual cycle, just as if it were in the uterus. Since the fluid cannot be flushed freely out of the body, it can build up inside, causing nearby tissues to become red, swollen, and painful.

Adhesions can also cause pain. This occurs when, during the healing process, tissues grow together, which can occur with infection, endometriosis, and surgery. Movements of the body will stretch the adhesions, causing discomfort or a sense of binding. If adhesions are found, they can be separated surgically during laparoscopy.

Infertility

Laparoscopy may be used to determine the cause of infertility. In some women the fallopian tubes are blocked. This can prevent sperm and egg from coming together, causing infertility. With laparoscopy, a simple test confirms this possibility. A colored fluid is injected through the uterus. If the tubes are open the fluid will flow out the ends of the tubes into the abdomen. The surgeon can see this through the laparoscope.

Cysts and Tumors

The ovaries sometimes develop cysts, or fluid-filled sacs. These cysts may be harmless, causing only mild pain. Some cause infertility or menstrual disorders. Ovarian cysts may disappear after a short time. If they don't, your doctor may want to perform laparoscopy to find out what type they are, since some of these cysts on the ovaries may need to be removed surgically. Tumors of the uterus can also be examined by laparoscopy.

Special Precautions

Some conditions increase the risk of complications with laparoscopy:

Sometimes a condition is serious enough to require laparoscopy, even though a patient has one of these medical problems. If so, it may be more difficult to insert the instruments into the pelvic cavity or to see through the laparoscope. In these cases, the doctor may have to make a larger incision to insert the instrument--this is called open laparoscopy.

Laparoscopy is an operation with minimal risk. Complications occur in about 3 of every 1,000 women who have diagnostic laparoscopy. These complications can include minor problems as well as injuries to nearby organs, bleeding, or complications from anesthesia. Talking over the possibilities ahead of time will help you prepare for them. Most often the problems can be treated and corrected. On occasion, the surgeon may need to make a separate incision and perform a separate operation.

Dr. Andrew Dott  teaches advances hysteroscopic and laparoscopic surgical techniques, is on the speaker's panels for several American pharmaceutical companies and is a professional lecturer.  He is available to travel and give seminars on the topics covered in this website both nationally and internationally.