The procedure is done under local or general anesthesia.
A tiny telescope is inserted into the uterus to observe
the cavity. It allows viewing of the inner lining of
the uterus (endometrium), shape, size, and diagnose
intrauterine problems such as adhesions, septum, polyps
or fibroids. If an abnormal condition is detected during
the diagnostic procedure, operative hysteroscopy can
often be performed to correct it at the same time, avoiding
the need for second surgery.
A Polyp is a benign growth from the endometrium. It
causes menstrual irregularities, heavy bleeding or infertility.
It can be removed by cutting the stalk with scissors
or shaved into pieces using an electric instrument called
the resectoscope which is introduced into the uterus
through the cervix.
Adhesions are fibrous or vascular strands that cause
the uterine walls to stick to each other. In severe
cases the cavity can be completely obliterated. They
cause scanty menstruation, amenorrhoea (absent menses),
recurrent miscarriage or infertility. Removal of the
adhesions is called adhesiolysis. They can be cut using
scissors or electric current through an operative hysteroscope.
Fibroids projecting in the uterine cavity (sub-mucous
myomas) can cause heavy menses, pain, dysmenorrhoea,
recurrent miscarriage or infertility. They can be removed
using the resectoscope by shaving the myomas into small
pieces and removing them through the cervix.
Alterations in the size, shape and capacity of the uterus
can occur due to congenital (uterine septum, T-shaped,
hypoplastic uterus) or acquired (previous infection,
previous surgery) conditions. Metroplasty is a procedure
where using operative techniques the uterus is restored
to its normal size, shape or capacity.
Tubal blocks can be due to mucous plugs, debris or thin
membranes covering the tubal ostia. A fine catheter
can be guided through the hysteroscope to open these
Misplaced or broken IUCD’s or fetal bones from
previous abortions can be retained in the uterine cavity.
They can cause irregular bleeding or infertility. A
forceps or grasper can be used to remove these objects
using an operative hysteroscope.
The procedure is done under general anesthesia. A thin
telescope is inserted through the umbilicus (belly button)
to look at the outside of the uterus, fallopian tubes,
ovaries, and internal pelvic area. If an abnormal condition
is detected during the diagnostic procedure, operative
laparoscopy can often be performed to correct it at
the same time, avoiding the need for second surgery.
Adhesions are fibrous or vascular strands that stick
pelvic organs like uterus, tubes, ovaries and bowel.
They result from previous infection or surgery. Although
in most cases, adhesions are innocuous, they can cause
pain, dyspareunia and infertility. Removal of the adhesions
is called adhesiolysis. They can be cut using scissors,
electric current or laser.
A polycystic ovary is a condition in which the ovaries
are bulky due to multiple (8 – 20) tiny follicles
in the ovary, diagnosed by ultrasonography. They suffer
from infrequent menses, irregular menses, obesity, hirsuitism
(excessive facial and body hair), and infertility. In
patients wishing to conceive, when medical treatment
fails, laparoscopic drilling of ovaries is performed.
A needle is used to drill multiple holes on the ovarian
surface using high frequency current. The procedure
leads to fall in hormone levels, normalization of menses
and improved fertility.
Cysts in the ovary could be due to hormonal imbalance
or tumor process. Majority of them are benign (non-malignant).
In young women wishing to preserve fertility, the cysts
can be treated laparoscopically by performing cystectomy
(removal of the cyst lining). The normal ovarian tissue
is preserved. The lining is put in a endobag and removed
from the abdomen.
Ovarian cysts or tumors which involve the entire ovary
or when they occur in elderly women (fertility preservation
not required), are treated by oophorectomy (removal
of the entire ovary).
Laparoscopy is ideally suitable for endometrisis surgery
as diagnosis, staging of the disease and treatment can
be performed in a single setting. It causes pelvic pain,
menstrual pain, painful intercourse or infertility.
The surgery can be fertility preserving/ enhancing in
younger women who wish to conceive or preserve fertility
or radical in older women who do not wish to conceive.
Read Endometriosis – treatment options
Fibroids are common tumors in the reproductive age group,
occurring in 20 – 25% of women. Although they
are asymptomatic in most women, they may cause pain,
heavy menstruation, pressure symptoms, infertility or
recurrent miscarriage. In symptomatic patients removal
of the fibroids (myomectomy) can be performed laparoscopically.
The surgery involves removal of the fibroid from the
uterus, reconstruction (suturing the defect) and removal
of the fibroid from the abdomen by morcellation (reducing
the fibroid into small chunks using a special instrument).
Pregnancy occurring in any site other than in the uterus
is called Ectopic. The commonest site for ectopic pregnancy
is the fallopian tube. Tubal ectopic pregnancy can cause
pain, and internal bleeding following tubal rupture
leading to shock or even death. If diagnosed early,
it can be treated by laparoscopy. Salpingotomy (incision
of the tube to remove the pregnancy) or Salpingectomy
(removal of the tube) can be performed.
Removal of the fallopian tube (Salpingectomy) may be
required when it is diseased due to infection or a cause
of pelvic pain.
Removal of the fallopian tube and the ovary may be required
when they are diseased due to infection or tumor.
Removal of the appendix
of Genital Prolapse
The pelvic organs can be displaced from its normal position
due to injury during delivery or weakening of pelvic
supports due to ageing or menopause. Genital prolapse
can cause backache, discomfort, urinary and bowel symptoms.
Pelvic reconstruction can be performed to repose these
organs to their normal position.
Removal of the uterus may be required in patients suffering
from menorrhagia (heavy menstruation), adenomyosis,
fibroids, genital infection, malignancy or prolapse.
Read Understanding Hysterectomy.