Laparoscopy and Hysteroscopy

Diagnostic hysteroscopy is a commonly performed gynecologic procedure to evaluate the endometrial cavity. This article focuses on the procedure of diagnostic hysteroscopy.

Broadly, 2 systems of diagnostic hysteroscopy exist: panoramic (also known as direct optical) and contact (also known as contact microhysteroscopy). Modern references to hysteroscopy usually imply a panoramic technique in which the uterine cavity is distended with liquid or gas and evaluated with the hysteroscope

Hysteroscopy is also used to examine the uterine cavity before women undergo in vitro fertilization. A slender instrument called a hysteroscope is inserted through the vagina and into the uterine cavity to look inside.

Diagnostic Laparoscopy

Exploratory laparoscopy (also referred to as diagnostic laparoscopy) is a minimally invasive method for the diagnosis of intra-abdominal diseases through direct inspection of intra-abdominal organs. Exploratory laparoscopy also allows tissue biopsy, culture acquisition, and a variety of therapeutic interventions. Laparoscopic ultrasonography (LUS) can also be performed during exploratory laparoscopy to evaluate organs that are not amenable to direct visual inspection.

The advent of laparoscopic surgery represents a landmark in surgery that initiated a shift from the era of open abdominal surgery to the minimally invasive surgery revolution. Today, laparoscopy is the most common and preferred method for addressing a number of routine and complex surgical procedures, such as cholecystectomy, appendectomy, splenectomy, adrenalectomy, and others

Laparoscopic Cystectomy

Laparoscopic Cystectomy is the removal of ovarian cysts. An oophorectomy is the removal of the ovaries, which can both diagnose and treat ovarian cysts by minimally invasive procedure where small incisions are made in the abdomen to insert a small camera and surgical instruments to record images that are then displayed on a monitor.

Symptoms

No symptoms at all.
Palpable mass or enlarged abdomen.
Abdominal pain with fever.
Difficulty passing stool or bloating.

Laparoscopic Myomectomy

Laparoscopic Myomectomy is the removal of uterine fibroids while leaving the uterus intact. It is the main treatment option for patients who would still like to conceive or prefer not to have a hysterectomy by minimally invasive procedure where small incisions are made in the abdomen over the area where the fibroid is. A camera and surgical instruments are inserted through these incisions to visualize the uterus and act.

Symptoms of uterine fibroids vary depending on their type, size, and position in the uterus. They are most commonly found in women between the ages of 30 to 50 who are still menstruating. Women who begin menstruation before the age of 12 are more likely to develop uterine fibroids. No connection has been found between birth control pills or hormone replacement therapy prescribed for menopause and uterine fibroids. Certain medical conditions, such as high blood pressure, may increase the risk of uterine fibroids by 24% when compared with women who have normal blood pressure.

Symptoms

The most common symptom of uterine fibroids is period that is heavier than normal and lasts longer than normal.
You may be palpable or may even be visible if it is large, resembling an early pregnancy, even though you might be menstruating.
You may have urinary incontinence or frequent urination, especially when you lie flat.
You may be constipated or feel pressure in your abdomen.
Feeling of fullness in the abdomen due to a fast-growing fibroid that may become malignant (Cancerous).
Some women experience painful sexual intercourse, but this symptom is uncommon.
Infertility.
Easy miscarriage.

Diagnosis

Physical examination, both external and internal.
Abdominal or transvaginal ultrasound.
Computed tomography (CT) or magnetic resonance imaging (MRI).
Hysteroscopy.
Laparoscopy.
Hysterosalpingography.

Treatment

If the fibroid is small, the doctor may recommend monitoring it or using medication and follow up with ultrasound as well as assess any vaginal bleeding associated with the growth The doctor may also test you for anemia. You will likely see your obstetrician/gynecologist (OB/GYN) every three to six months.
If the fibroid causes excessive bleeding, medication may be prescribed to reduce the amount of blood that is lost.
Myomectomy.
Hysterectomy to remove the uterus (only in severe cases where the patient no longer wishes to have children).

Laparoscopic Hysterectomy

A hysterectomy is the surgical removal of the uterus. Hysterectomies are performed for a wide variety of reasons. A hysterectomy is major surgery, but with new technological advances, the discomfort, risk of infection and recovery time has all been decreased.

There are currently three surgical approaches to hysterectomies. These include:

Open, traditional hysterectomy. This involves a six to twelve inch incision made in the abdominal wall.
Vaginal Hysterectomy. This involves removing the uterus through the vagina. This approach is better than the open, traditional hysterectomy, but still does not allow the surgeon a full view of the surrounding organs, including the bladder.
Robotic-Assisted Radical Total Laparoscopic Hysterectomy. Using a state-of-the art robotic platform allows the surgeon a full view of the surrounding organs and more precise control over incisions.

Hysterectomy offers numerous potential benefits over traditional approaches to vaginal, laparoscopic or open abdominal hysterectomy, particularly when performing more challenging procedures like radical hysterectomy for gynecologic cancer. Potential benefits include:

Significantly less pain
Less blood loss
Fewer complications
Less scarring
A shorter hospital stay
A faster return to normal daily activities
Decreased risk of infection

Laparoscopic Hysterectomy

Operative hysteroscopy is a minimally invasive procedure used to treat uterine disorders without open surgery. Using a hysteroscope, the uterus can be accessed through the vagina and cervix without any incisions through the abdominal wall.