Laparoscopy/ Hysteroscopy - Infertility

About Gynaecological Laparoscopy and Hysteroscopy

Laparoscopy uses a small camera to check the pelvic cavity, fallopian tubes and ovaries. This examination helps us to understand why women suffer from infertility. During laparoscopic surgery, a doctor makes some small cuts (0.5-1cm in size, 2-4 cuts) on patient’s abdomen in order to insert the laparoscope and relevant laparoscopic instruments. Pain is much reduced due to smaller incisions compared with open surgery, and recovery time is relatively shorter. Scars are also barely visible following recovery. Some patients may undergo a hysteroscopic surgery at the same time. Hysteroscopy is the inspection of the womb (uterine) cavity by a camera which is inserted through the vagina and neck of the womb (cervix).

Laparoscopy and hysteroscopy are not only used for infertility diagnosis, but also serve as a means of therapeutic surgery in infertility.

Application of Gynaecological Laparoscopy

1) Diagnosis

By using a laparoscope the doctor can make diagnoses such as endometriosis and pelvic adhesions. Furthermore, by injecting a blue dye (indigo carmine) into the womb, fallopian tubes can be assessed for their patency.

2) Treatment

Applicable to infertility treatment including:-

Removal of tubal, ovarian and pelvic adhesions, treatment of endometriosis, re-opening of blocked tubes, reverse sterilization by tubal re-anastomosis, ovarian drilling or removal of benign ovarian cysts.

Application of Gynaecological Hysteroscopy

1) Diagnosis

By using a hysteroscope the doctor can make diagnoses such as polyps, fibroids, adhesions or uterine anomalies.

2) Treatment

Applicable to infertility treatment including:-

Removal of polyps/fibroids, division of uterine adhesions, division of uterine septum.

Preparation for Gynaecological Laparoscopic and Hysteroscopic Operation

The operation is usually performed during the first 14 days of the cycle. If the patient has irregular periods and cannot predict exactly when the next period will be or the operation is not scheduled in the above said period, the patient should not have unprotected intercourse since her last period before operation. The operation has to be re-scheduled if there is a chance that the patient might be pregnant. In addition, the patient is not allowed to eat or drink after midnight prior to the day of operation.

Operation Procedures for Gynaecological Laparoscopy and Hysteroscopy

Laparoscopy and hysteroscopy are performed under general anesthesia. During the operation, carbon dioxide gas is pumped through a tube to inflate patient’s tummy (abdomen). A doctor will then make small cuts (incisions) of around 0.5-1 cm each, which are usually placed near the belly button and lower left and right part of the abdomen. Instruments are inserted through these incisions for diagnosis and operation. During laparoscopy, a small tube will be passed through the vagina and cervix into the uterus. The doctor will then inject a small amount of indigo carmine into the uterus through the tube to check the patency of fallopian tubes. If hysteroscopy has to be performed at the same time, the doctor will use a saline solution or glycine to distend the uterine cavity. A hysteroscope will then pass through the vagina and cervix into the uterus to check for any pathology.

In general, if infertility is caused by pelvic or uterine cavity pathologies, the doctor will perform a therapeutic operation for the patient. However, not all the diseases can be treated by this operation. The efficacy of the operation depends on the extent of the organ damage. Hence, the doctor has to assess the patient’s conditions and determine whether the therapeutic operation should be performed.

The patient will be monitored for a few hours after the operation. She is allowed to eat and drink when she is fully awake. Compared to a traditional open operation, there is usually less pain following the laparoscopic operation but the patient can take some painkillers if needed. The incisions near the belly button and the abdomen are closed with a few dissolvable stitches. Patients are usually allowed to go home the next day after the operation and most of them will be fully recovered in 1-2 week time.

Risks and Complications for Gynaecological Laparoscopy/Hysteroscopy

Laparoscopy and hysteroscopy are minimally invasive and safe surgical procedures. Complications after a laparoscopy and hysteroscopy are rare, but can include bleeding, infection, and accidental damage to cervix or uterus and nearby organs (bowels, bladder, ureters and blood vessels). If a complication does occur, a traditional open surgery might have to be performed. In addition, for those patients who are using glycine during hysteroscopy, they may have abnormal post-operative electrolyte levels due to excessive absorption of glycine. However, the complication rate is very low. In general, laparoscopy and hysteroscopy are relatively safe procedure.