Laparoscopy and dye test.
This is performed as a diagnostic or a therapeutic procedure in a patient with subfertility.
In a diagnostic surgery after gaining access to the abdominopelvic cavity via three ports, a colored dye (methylene blue) is injected through the cervix. If the tubes are not blocked the dye should pass along them and spill into the abdomen. In addition to that Laparoscopy allows the internal organs of the abdomen and pelvis to be inspected visually and excludes other problems such as endometriosis, fibroids, ovarian cysts and adhesions.
The procedure becomes therapeutic if adhesiolysis, removal of fibroid or endometrioma were done at the same time.
Other Laparoscopic surgeries in Gynaecology
Diagnostic Laparoscopy
Frequently, the surgeon needs to assess the pelvis for acute or chronic pain, ectopic pregnancy, endometriosis, adnexal torsion, or other pelvic pathology. Usually, a primary port for the laparoscope is placed infraumbilically and second ports are placed in the lower abdomen to observe pelvic organs. If needed, a biopsy specimen can be obtained to aid in the diagnosis of endometriosis or malignancy.
Diagnostic laparoscopy is usually performed under general anesthesia, with endotracheal intubation to minimize the risk of aspiration.
Tubal sterilization.
Trocar placement is similar to diagnostic laparoscopy. The tubes are occluded at the mid-isthmic portion, approximately 2 cm are occluded.
Ovarian Cystectomy
After gaining access to the abdomen ovarian cyst is identified. Then biopsies can be taken, the cyst can be removed or oophoretomy can be done.
Myomectomy
Adhesiolysis
Treatment of Ectopic Pregnancy
Laparoscopic salpingostomy or salpingectomy may be performed to remove the embryo and gestational sac.
Laparoscopic Hysterectomy
In the total laparoscopic hysterectomy, the laparoscope is used to remove the uterus and oophorectomy may and may not be done at the same time. Access is gained via umbilicus and two lower abdominal incisions. During this uterus is separated from its ligaments and blood vessels, and then detached it with an incision at the top of the vagina.
Laparoscopic Supracervical Hysterectomy
This is similar to total abdominal hysterectomy. First the supra cervical part is detached from the ligaments and blood vessels then it is detached from the cervix and uterus is removed from the lower abdominal incision.
Laparoscopic Burch Procedure
This is used for women with stress incontinence. After gaining access via Umbilicus and two lower abdominal incisions the neck of the bladder is attached to the Cooper’s ligament via a permenant stitch.
Laparoscopic vault suspension
In this abdominal access is similar to above procedures.The vault of the prolapsing vagina is attached to the uterosacral ligament.
