Laparoscopy is a surgical procedure involving the use of a scope and small instruments to look into the abdomen for diagnostic or operative purposes. There are many indications for having a laparoscopy performed.
- Pelvic pain
- Pelvic adhesions
- Ectopic pregnancy
- Evaluate the uterus
- Evaluate fallopian tubes
- Search for an explanation of Infertility
The procedure is conducted under general anesthesia. An incision is made into the belly button (umbilicus). A needle is then inserted through this incision into the abdomen. CO2 gas (like the bubbles in soda) is used to create an air pocket in the abdomen. The insufflating needle is then removed and a 5, 10, or 12 mm trocar is inserted through the incision. The camera can now be introduced into the abdomen. Once the abdominal wall has been inspected a smaller trocar is usually inserted above the pubic bone. A manipulating instrument is then used to move the abdominal contents around for inspection. Photographs like the one below can be taken.
When necessary, additional trocars and instruments can be used to perform operative laparoscopy. Many operations can be performed laparascopically which minimizes the patients recovery time. Cystectomies, myomectomies, and lysis of adhesions are but a few examples of the many procedures possible.
Recovery is often very rapid. Patients will have 2-4 incisions each less than 1/2 inch in length that usually heal without difficulty. Most patients are able to resume full activities within 2-3 days after laparoscopy. Some of the things patients may notice are a sore throat, abdominal discomfort, and shoulder pain. The shoulder pain is a result of the gas in the abdomen and a referred sensation to the shoulder.
Click on any image for a larger view This picture demonstrates a normal appearing fimbria. The fimbria is the finger like projections at the end of the tube that help in the collecting the egg into the tube. This image demonstrates a normal pelvis. There are no adhesions, endometriosis, or uterine leiomyomas visible. This picture demonstrates a normal ovary and fallopian tube. The uterus is seen in the background. The appendix is usually apparent if the surgeon looks for it. Sometimes endometriosis can be found at the tip of the appendix. The one shown here is completely normal. This is blood in the cul-de-sac (space behind the uterus) which is a finding consistent with retrograde menstruation. Menstrual flow out of the fallopian tubes is thought to be related to endometriosis. A normal liver can be seen in this photo. A glimpse of the white gallbladder is visible just under the edge of the liver. This liver has scar tissue attaching it to the abdominal wall. This is seen with some types of pelvic infections such as gonorrhea. Frequently the surgeon will also find scar tissue around the tubes. This is an enlarged ovary containing an endometrioma or “chocolate cyst”. These are cysts with endometriosis tissue inside of it. Click the image to see an ultrasound picture of this cyst.