Diagnostic laparoscopy is a minor surgical procedure that visualizes the abdominal and pelvic cavity to evaluate and treat gynecologic and reproductive medicine abnormalities. It is done as an out-patient under general anesthesia, by inserting a small rigid viewing telescope, known as a laparoscope, through the belly button (umbilicus) and into the abdomen. Frequently, one or two additional incisions are made right above the pubic bone, to insert additional instruments, in order to be able to "operate" and remove underlying pathology, like an ovarian cysts, endometriosis/endometrioma, pelvic adhesions and scar tissue, and many times just for evaluating the pelvis in a woman who is having trouble getting pregnant.
While the patient is asleep, the abdomen is filled with carbon dioxide (CO2), in order to distend the abdominal cavity to make visualization of the reproductive organs possible. Sometimes, after the procedure, the woman may experience some shoulder pain, mainly on the right, from some of the CO2 getting under the diaphragm and irritating it. This causes referred pain to the shoulder(s). She may also feel a "heaviness" in her chest, again from the CO2. The CO2 will be absorbed over the next day or so, and all the discomfort will be gone. Laparoscopic surgery usually takes an hour or two. Afterwards, the small incisions are closed with tiny sutures under the skin. Recovery time is generally a day or so, and the woman can go back to her normal activities, without any restrictions.
Diagnostic and operative laparoscopy is used both for diagnosis and treatment. It may be recommended for:
- Treatment of a persistent ovarian cyst found on ultrasound or pelvic examination that does not go away with medical treatments
- Treatment of known endometriosis by laser vaporization or cautery, or the removal of an endometrioma found on ultrasound
A graphic representation of a left ovarian cyst and adhesions - a sac filled with fluid, simple cyst, or a semisolid material, like an endometrioma (chocolate cyst) or dermoid, both benign tumors of the ovary, that develops on or within the ovary. It may also be surrounded by scar tissue, as in the above illustration. Simple ovarian cysts are relatively common in women of reproductive age and usually disappear without treatment.
- Diagnosing a woman for possible appendicitis or infection of her fallopian tube, known as salpingitis or pelvic inflammatory disease (PID)
- Evaluation of unexplained infertility. 30-40% percent of the time, if the rest of the infertility evaluation fails to find anything, the cause will be found during the diagnostic laparoscopy - asymptomatic endometriosis or pelvic adhesions secondary to undiagnosed chlamydia
Graphic representation of left adnexal adhesions between the left tube and ovary secondary to a pelvic infection from chlamydia, immobilizing the fallopian tube so it cannot move and pick up an egg.
- Evaluation of pelvic pain, especially in a woman who has infertility, when ultrasound findings are negative
- Evaluation of the uterus after a perforation from a D&C
- Evaluation and surgical treatment for an ectopic or tubal pregnancy
- Removal of subserosal fibroids
- Although, Arizona Center for Fertility Studies "hates" to say this, for tubal sterilizations
- Egg recovery for the GIFT procedure and to put back embryos for the ZIFT
- To replace the need for an open procedure, where a 2-4 inch incision is made horizontally above the pubic bone, known as a laparotomy. Although, at times, because of the pelvic findings, a laparotomy is needed to get the desired results
Graphic representation of a laparoscope placed through the belly button and an additional instrument inserted right above the pubic bone.
Graphic representation of different areas where adhesions or scar tissue can develop
Your doctor is considering a surgical procedure called laparoscopy. This is a procedure in which the doctor makes surgical cuts in the lower part of the bell and inserts a special scope into the belly. This scope allows the doctor to see inside the belly and also to perform simple surgical operations inside the belly. A laparoscopy not for sterilization or ART (Artificial Reproductive Technologies) is usually done only for the purpose of diagnosis, which means that it is not being done for treatment of any disease or condition, but only to help the doctor find out if any disease is present.
Complications from laparoscopy are very uncommon, but they do sometimes occur. Your doctor can make no guarantee as to the result that might be obtained from this procedure. It is possible that the doctor will be unable to successfully complete the procedure because of technical problems. It is also possible that because of complications or because of the discovery of life-threatening abnormalities, immediate major surgery inside the belly will be necessary. Some of the possible complications of laparoscopy are:
- Bleeding, infection, generalized disease and inflammation of the lining of the belly, damage to the stomach and intestines, abnormal air collections underneath the skin and in the chest, ruptures or hernias in the surgical wound and through the breathing muscles (diaphragm), sterility or the inability to bear or have children, damage to the kidneys and urinary system, blood clots in the pelvis and lungs, nerve injury, and allergic and other bad reactions to one or more of the substances used in the procedure.
Some of the complications of this procedure may require major surgery, some of the complications can cause poor healing wounds, scarring and permanent disability; very rarely, some of the complications can even be fatal. Furthermore, there may be alternatives to this procedure available to you, such as the use of other types of diagnostic tests. However, these alternative methods carry their own risk of complications and a varying degree of success. Therefore, in those patients in whom laparoscopy is indicated, the procedure may provide the patient with the chance of successful diagnosis and lowest risk of complication
Like any other surgery, the experience and expertise of the reproductive surgeon, makes all the difference in having an outcome that preserves future fertility and childbearing potential and safeguards against any serious complications. Results from anesthesia are also rare in a young healthy woman of reproductive age. Arizona Center for Fertility Studies has a tremendous amount of experience and expertise with laparoscopic surgery and has never had a serious complication.