What procedures can be performed during a laparoscopy?

The Fallopian tubes can be tested for infertility (the so called “blue tubal test”): during this procedure a liquid dye is injected through the cervix, then with the aid of the coelioscope the surgeon can verify that the liquid flows through the tubes (tubal permeability).

Tubal repair surgery for infertility: if the tubes are blocked or damaged, there are certain procedures that can restore their permeability (by removing adhesions or “unzipping”...)

Fallopian tube ablation or Salpingectomy: when a Fallopian tube is damaged or does not function well, the tube can be (or may have to be) removed.

Treatment of an extra-uterine (ectopic) pregnancy: in these cases the surgeon decides according to the state of the Fallopian tube, either to: make a small incision in the tube and aspirate the gestational sac (salpingotomy and tube conservation) or             remove the Fallopian tube if it is too damaged. Conserving the Fallopian tube may have more disadvantages than advantages: risk of secondary haemorrhage, pregnancy persistence, residues of placenta, recurrence of extra-uterine pregnancy…). The surgeon takes the appropriate decision during the coelioscopy procedure.

Cyst or ovary removal (ovarian cystectomy): some organic cysts can become very large or, during an ultrasound scan some cysts can appear suspicious. In these cases cyst removal is required either for further analysis or to avoid ovarian or tube torsion (twisting), or to improve the functioning of the ovaries. In this case the surgeon separates the cyst wall from the ovary in order to maintain proper ovary functioning.

Ovarian removal (Ovariectomy or Oophorectomy): this procedure is required when there is a risk of degeneration. or when there is no need to preserve the ovary (for example, after menopause), or when the ovary is completely “blown” by the cyst with no chance to save any healthy tissue.

Adnexectomy (ovary and tube removal): this procedure is required when there is a risk of degeneration.

Endometriosis: endometriosis is the presence and growth of soft womb lining tissue from the endometrium in non-appropriate areas (such as the ovaries, the peritoneum, the Fallopian tubes, the intestines...). During the menstrual cycle these fragments “bleed” and cause an inflammatory reaction in the areas where the tissue is present (often accompanied with specific pain). The coelioscopy enables the surgeon to “view through” the abdomen and precisely locate the lesions before proceeding to destroy or excise them with the aid of an endoscope.

Fibroma removal (Myomectomy): this is the removal of a myoma with the aid of an endoscope that the surgeon inserts through the belly button. The surgeon also performs three 1 cm large incisions in the lower part of the abdomen. This method is only appropriate when there is a single myoma or only a few myomas each of a relatively small size. The phases of the dissection are identical to those of a laparotomy, however most of the time the surgeon sutures at a single level. (See the section on myoma/fibroma)

Hysterectomy (uterine removal): is the removal of the uterus via coelioscopy. The surgery proceeds with the aid of an endoscopic camera placed near the navel. Then the surgical trocars with operating instruments are inserted through two or three cuts measuring 5mm to 1 cm in diameter, placed in the region above the pubis. (see the section on hysterectomy)
This method enables the surgeon to conduct the procedure in a way similar to the classic laparotomy. However for success it requires that the endoscopic procedure not be complicated as regards the position of the uterine ligaments and as such the uterus should not be large.
In contrast, because there is no opening in the abdomen muscle wall, in general the coelioscopy enables a faster recovery than the laparotomy.
The objective of this procedure is to preserve the cervix.
This method can be used for cancer treatment, in particular for removing pelvic lymph nodes.

Prolapse surgery (using coelioscopy to treat pelvic organ descent): the objective of the coelioscopy here is to move the pelvic organs up (bladder, rectum, vagina, or cervix) by reproducing “traditional” surgery that fixes the cervix (or the uterus, or the base of the vagina) to the pre-vertebral ligaments of the sacrum area using a tissue “support bandage”.

Pelvic excision (removal of the pelvic lymph nodes): required in situations of cancer of the uterus or the ovaries. This procedure involves removing the nodes that “filter” the uterus in order to monitor the possible persistence of cancerous cells and decide the type of appropriate treatment going forward.

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