Why & When Laparoscopic Surgery in Infertility with tubal pathology

Video: https://youtu.be/fuVS8oFIriw

Why:

When HSG or pelvic sonography shows tubal disease-block or hydero-salpinx and in event of accidental death of child with previously done family planning operation done in the past. This surgery requires lot of experience & expertise. This also requires advanced laparoscopy set up which includes HD/3D camera, special needle holders and specially designed micro-instruments are must to achieve good results. Reversal of Laparoscopic Tubal Ligation gives better results compared to Abdominal Tubal Ligation operation. Patient can be discharged within 24 hours with excellent results.

Benefits of Laparoscopy Surgery:

1. Shorter Hospital stay,
2. Earlier return to your routine work,
3. Cosmetically vary small scar,
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:

• Investigation for Surgery (Urine complete & Blood complete, HbsAg, HIV, R.B.S.Etc.); Pelvic Trance vaginal USG report, Blood tests for Tumor markers.
• Specific Investigations for Infertility (Endocrine, Blood, Genetic, Husband’s Semen report etc.)
• AMH (Ovarian reserve should be normal) report should be normal, as it is major surgery.
• Operation planned from 4th to 10th day of Menstrual Cycleif, laparoscopy is done for Infertility.
• Enema & preparation/shaving of local parts. Liquid diet for two days prior to operation and Peglac is dissolved in one liter of water and advised to take orally 6 hours before operation for special bowel preparation before laparoscopy.

No. Of Cuts on Abdomen:
Four cuts: all of 5 mm size.

Average Stay in Hospital:
24 hours

Average Duration of Surgery:
30-40 minutes

Average Blood loss during Surgery:
10-30 cc

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)

Operative 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 three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made inside the navel, and another two ports are usually kept on Lt. Side and one on Rt. Side and one at midline suprapubic near the supra pubic area. The first incision allows a needle to be injected 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 organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.

Special Uterine manipulator is introduced in the uterus from below for manipulating uterus and for tubal testing during surgery. Proximal and distal stumps are prepared using fine monopolar hook and scissor so methyline dye comes from both stumps freely. Both stumps are approximated adequately with few mesosalpinx stitches with No.6 prolene. The most important “6” stich is taken with 7-0 prolene by outside-inside stitch proximal stump & inside to outside stitch from distal stump for better alignment of ananstomosis of tubal lumen. Then another 3 stitches are taken at ‘12” O’ clock,”3” O’ clock and at “6” o’ clock sites with sparing endosalpinx in stitch. Same procedure is done on another side of the tube.

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 & shoulder pain after laparoscopy for 24 hours but it cam be relived 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 for dressing.