Why & When Diagnostic Laparoscopic & Hysteroscopic Surgery & Infertility

 

 

 

When:

If patient is actively trying for conceiving for more than two years, with all other reports normal and not getting result, desiring for spontaneous natural conception before IVF, Laparoscopy & hysteroscopy is advised.

Objective:

Diagnostic Laparoscopy & Hysteroscopy is the commonest type of work up in the entire Infertility patient. We record both Laparoscopy & Hysteroscopy diagnostic & operative procedure for future important record in Infertility patient, for second opinion & for understanding prognosis in different treatment protocol. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable. It will be stich less and day care surgery.

Benefits of Laparoscopy Surgery:

1. Shorter Hospital stays.
2. Next day returns to your routine work.
3. Cosmetically vary small scar & not visible after few months.
4. Less pain after operation.
5. Best fertility enhancement & Fertility results following Laparoscopy.
6. Video-live operative file available in CD/DVD for future reference (Transparency about surgical procedure).
7. The possibility of post-operative adhesion formation will be less, and the possibility of pain because of post-operative adhesions will also be less.

Pre-operative Check Lists:

1. Pre-operative Lab. Investigation for Surgery (Urine complete & Blood complete, HbsAg, HIV, HCV, R.B.S.Etc.); Pelvic Trance vaginal USG report.
2. Specific Investigations for Infertility (Endocrine, Blood, Genetic, Husband’s Semen report etc. If The couple is infertile)
3. Pre-operative Physician fitness with ECG,
4. Operation planned from 4th to 10th day of Menstrual Cycle.
5. Enema & preparation of local parts.

 

No. Of Cuts on Abdomen:
Two cuts: One of 5 mm & second of 3 mm size

Average Stay in Hospital:
4 to 6 hours. (DAY CARE SURGERY)

Average Duration of Surgery:
10 to 20 minutes

Average Blood loss during Surgery:
Negligible

Average time after operation to resume normal activities/work:
Within 24 hours.

Anesthesia:
General Anesthesia (Patient will not feel any pain in Operation Theatre during surgery)

 

Procedure:

Inside the Umbilicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images – and sends them to a monitor so the surgeon can see what is going on inside.

Performing Laparoscopy usually only requires two tiny incisions less than one half cm, (about 3-5 millimeters) in length. One incision is made inside the navel, and another is usually made near the bikini line. The first incision allows a needle to be introduced into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen, which helps to keep intestines & omentum up and away from pelvic organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed.

Observing free spill with methyline blue from both fallopian tubes is not enough and complete search is necessary to find out various causes responsible for Infertility work up during Laparoscopy. We specifically see on both ovarian fossas after lifting the tubes for the possibilities of Endometriosis.  We also see for Tuberculosis & PID in all the cases. Hysteroscopy done without dilatation of the cervix and flushes both fallopian tubes with high pressure fluid helps in achieving very good fertility enhancing results following Hysteroscopy in infertility patients. Addressing all the infertility related lesions like PCOD, Endometriosis, Adhesiolysis, Fibroid etc. helps us in treating infertility patients in the same sitting.

Post-operative Course:

Patient remains drowsy/sedated for 2-3 hours after laparoscopy but conscious & pain free. Patient can take fluids 3-4 hours after laparoscopy & light food after 4-6 hours. She may feel little abdominal pain after laparoscopy for 24 hours but it can be relieved with pain killer tabs. Most of the patients can walk normally without support and can take normal diet 6-8 hours after the laparoscopy. She can be discharged on the same day of the operation. Few patients may feel nausea & vomiting after laparoscopy, which can be very well controlled with injection in post-operative room. Patient can do her normal activity within 24 hours after laparoscopy. Patient is advised to take antibiotics & analgesic tabs. for 5 days following laparoscopy. Patient is advised to report to doctor for severe pain or bleeding or fever in postoperative period (Day-1 to Day-5) immediately. Patient is advised to come for follow up 7 days after the Laparoscopy.