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Endoscopy
Operative Laparoscopy

During diagnostic laparoscopy the laparoscope is used just to observe the outside of the uterus and tubes, ovaries and pelvis.

Listed below are the operative procedure that can be carried out :

 

Fallopian Tube Catheterisation

Fallopian Tube Catheterisation is today the first line of management for blocks at the junction of the tubes with the uterus, i.e. the cornual end of the tube. This pathology which previously needed microsurgery can in a large number of cases be managed endoscopically by passing a fine catheter through a hysteroscope to by pass the block under laparoscopic control. This pathology can also be managed by passing the block with the help of a catheter passed under fluoroscopic guidance, a procedure similar to cardiac angioplasty to open blocked arteries. The latter method can be performed under local anaesthesia as against general anaesthesia for the former.

 

Salpingostomy

Hydrosalpinx is a fallopian tube that is blocked at its outer end. It is dilated and fluid filled and usually caused by a previous pelvic infection, surgery or endometriosis.

In mild cases fertility may be restored by opening the tube surgically. In the past this surgery was performed using microsurgical techniques but today the trend is towards laparoscopic management with a 30% chance of pregnancy. When the tubes are badly damaged IVF is the treatment of choice.

There is some evidence that the presence of a hydrosalpinx reduces the success rate of IVF and increases the risk of miscarriage.The fluid from the hydrosalpinx is said to ‘wash’ away the embryos. For this reason, doctors advise removing, or occluding the hydrosalpinx through the laparoscope before the IVF treatment.

 

Adhesiolysis

Adhesions are the sticking together of the tubes and ovaries to each other, or to other pelvic structures as a result of infection, surgery or endometriosis. As a result, the tubes are unable to effectively pick up the eggs released by the ovaries resulting in a failure to conceive or an ectopic pregnancy. The adhesions may also cause pelvic pain. Treatment of this problem usually requires  laparoscopic surgery to release the adhesions. Flimsy adhesions when released can restore fertility while thicker and more extensive adhesions may require IVF-ET .

 

Ectopic Pregnancy

 

 

Ovarian Drilling ( LEOS)

In patients with Polycystic Ovarian Syndrome , a laparoscopy is performed and then each ovary is pierced six to eight times each, using an electrical current which is passed through the needle. This serves to ultimately destroy some of the male hormone (androgen) producing tissue in the central portion of the ovary, facilitating ovulation. Side effects are rare, but adhesion formation and ovarian failure have been reported.

 

Tubal ligation

Tubal ligation is the surgical procedure commonly known as "tying the tubes". Tubal ligation permanently sterilizes a woman by preventing transport of the egg (ovum) into the uterus, and by blocking the passage of sperm into the tube where fertilization normally occurs. Using instruments that are inserted through the laparoscope or mini laparotomy, the sterilization involves simply tying, clipping, banding, or burning of a small part of the fallopian tubes

Tubal ligation is a permanent form of contraception and can only be reversed by another surgical procedure known as Microsurgical Tubal Reanastomosis.

Ideally, only a small length of tube should be obliterated at the isthmus, preferably with a clip or band , as the success rates of microsurgical reversal of the sterilisation procedure can then be as high as 80 – 90 %.

 

Endometriosis

 

Fibroids

 

Hysterectomy

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