Laparoscopy
From Encyclopedia of Sex and Sexuality
A medical procedure used to inspect the inside of the abdominal cavity with a telescopic instrument called a laparoscope. The procedure is also called pelviscopy. The operation is frequently done as an out-patient procedure, as it has a much shorter recovery time than an exploratory operation in which the abdomen is cut open. However, as with any procedure in which instruments are placed inside the abdominal cavity, it is considered a major surgical operation. The laparoscope is inserted into the abdominal cavity through a small incision made below the navel. To make viewing easier and decrease the chance of damaging tissue, before the laparoscope is inserted, the abdominal cavity is distended by inflation with a gas, usually carbon dioxide, inserted through a needle puncture into the abdomen. After the laparoscope is in place, additional small incisions can be made to enable other instruments to be utilized for probing, manipulation, or surgery. The laparoscope allows for a complete inspection of the abdomen: all the organs inside the abdominal cavity can be viewed directly.
There are two general reasons for performing laparoscopy: diagnostic and therapeutic. Diagnostic reasons include evaluation of patients suffering pelvic pain or patients with difficulty becoming pregnant. The uterus can be seen with the laparoscope and, utilizing an instrument in the vagina that manipulates the uterus, it can be elevated so that there is vision around and behind it. Irregularities of the uterus such as uterine fibroids can be seen directly. The fallopian tubes, which transport the egg from the ovary to the uterus, can also be observed directly and evaluated for inflammation or blockage. Dye can be introduced through the cervix and, if the fallopian tubes are open, it can be seen to exit from the upper ends of the fallopian tubes and enter the abdominal cavity. In this way laparoscopy can be used to determine if tubes are open or closed. The ovaries can also be seen directly, as can the presence of cysts, evidence of ovulation, and other structures in the abdomen.
The most common therapeutic laparoscopy procedure is tubal sterilization to prevent pregnancy. Under direct vision, the fallopian tubes can be blocked by cauterizing a segment of each tube with an electric current or a laser or obstructed by placing bands around their midportion. Through the laparoscope, adhesions (abnormal areas of scar tissue that bind together tissues that are not normally held together) can be cut or cauterized. Similarly, areas of endometriosis can be surgically destroyed and small cysts can be aspirated (have their contents sucked out) using a laparoscope. Occasionally, fallopian tubes can be repaired through use of this instrument. Another common usage of laparoscopic surgery is the removal of an ectopic pregnancy. The fallopian tube can be removed or the pregnancy removed from the fallopian tube using laparoscopic instruments only. Some ovarian cysts may be removed through the laparoscope and occasionally ovaries may be removed too. Using the laparoscope, the fallopian tubes and ovaries can be freed from their attachments to the body, enabling vaginal hysterectomies (see hysterectomy) to be performed in cases when major abdominal surgery would once have been necessary. General surgeons have recently begun using the laparoscope to remove gallbladders.
In recent years the use of the laparoscope has been expanded so that now it is increasingly common to perform major operative procedures with it. This shortens the hospitalization and recovery period. Minor complications of laparoscopy include infection at the site of the abdominal puncture or an ecchymosis (black and blue area) around the puncture site. Serious complications can also occur, including injury to the bowel or major vessels in the abdomen. These complications may require immediate major surgical intervention. As with all operations, there is the possibility of complications from anesthesia as well.
