Laparoscopy -- The Kinder Cut
from the book How to Have a Baby:
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani, MD.
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After the operation, there may be some discomfort. This may include:
- Mild nausea as a result of the medication or the surgical procedure
- Pain in the neck and shoulder due to the gas inside the abdomen
- Pain in the areas where the instruments passed through the abdominal wall
- A scratchy throat and hoarse voice if a breathing tube was used during
- Cramps, like menstrual cramps
- Discharge like a menstrual flow for a day or two
- Muscle aches
Most of these minor symptoms will disappear within a day or two after
surgery. The abdomen may feel swollen for a few days. Any unusual or peculiar
symptoms should be reported at once to the doctor.
To really appreciate the benefits of laparoscopy, one should remember that
the alternative is major surgery (laparotomy) which involves a large abdominal
incision, a four to six day hospital stay, and four to six weeks of
postoperative recovery time.
While the doctors may term laparoscopy as being "minor" surgery,
remember that for the patient all surgery is major! The risk of laparoscopy are
minimal. But certain conditions increase the possibility of complications. If
there has been previous surgery in the abdomen, especially involving the bowel,
there is an increased risk. Other conditions that lead to a higher risk of
complications are evidence of an infection in the abdomen, a large growth or
tumor within the abdomen, and obesity.
Complications among young, healthy women under going laparoscopy are rare and
occur only in about three out of 1000 cases. These complications can include
injuries to structures in the abdomen such as the bowel, a blood vessel or the
bladder. Most often, these injuries occur when the laparoscope is placed through
the navel. If such an injury occurs during the procedure, the physician can
perform major surgery and correct the damage through a longer abdominal
incision. Sometimes, complications may arise after surgery. If bleeding or pain
appears excessive or if high fever develops, the doctor should be informed.
Where to do the laparoscopy
In order to choose the best doctor for performing your laparoscopy, you need
to ask the following questions.
- How many laparoscopies have you done?
- Do you use multiple punctures?
- Do you use a video for recording the operation?
- If you find a problem, will you correct it at the same time? Ideally, if
the doctor finds a problem during the laparoscopy, he should correct it at
the same time, rather than call you again for a second surgical procedure,
which only adds to your expense and risk.
Comparing laparoscopy and HSG
A common question patients ask is if they can go in for an X-ray (hysterosalpingogram)
instead of a laparoscopy to find out if their tubes are open? While it is true
that an HSG will provide accurate information about whether or not the tubes are
open, there are other major benefits which laparoscopy offers and which HSG does
not. HSG provides information only about the inside of the tubes and uterine
cavity, whereas in laparoscopy, not only can the tubal patency be determined,
but other disorders inside the abdomen which affect tubal function and which do
not show up on HSG (such as endometriosis and tubal adhesions) can also be
diagnosed. Moreover, major bonus in the case of laparoscopy is that it offers
the doctor a chance to diagnose and treat the problem at the same time if
possible - double bonus! Of course, the advantage of HSG is that no surgery,
hospitalization or anesthesia is needed: it is less expensive; and that a hard
copy record is provided, which all doctors can refer to later on. In fact both
the HSG and laparoscopy are complementary procedures, and you may even need
both, especially if your tubes are blocked.
A common problem which patients face in practice is that many doctors will
insist on repeating the laparoscopy. One reason for this is that doctors feel
that they need to do the laparoscopy for themselves, because they cannot
"trust" another doctor's judgment. This is, of course a major problem
for patients, who suffer repeated (and unnecessary) laparoscopies. Having a
video record should help to minimize this problem. What happens if your
laparoscopy was normal and the second doctor wants to repeat it anyway?
Sometimes doctors have little to offer in the way of effective treatment and
since there is nothing else to do, they suggest a repeat scopy to which the
hapless patient is forced to agree. If your first scopy did, in fact indicate
you had a problem, a second look laparoscopy may be indicated (and this should
have been discussed with you after the first scopy) to determine if the problem
has been successfully resolved. Ask the doctor what information he hopes to get
by doing the repeat laparoscopy and how this will change your treatment. If you
feel the doctor wants to do a scopy for no very good reason, refuse. It's a
surgical procedure after all - and it's your body.
Thinking it over
A major benefit of laparoscopy is that in addition to allowing the accurate
diagnosis of a problem, if it exists, operative laparoscopy can also be done in
the same surgery to correct the problem. Often, the laparoscopy provides
reassurance that the woman is normal and that the chances of having a baby are
therefore good. In such cases, it even allows the doctor to perform treatment
for the infertility in that cycle, if appropriate, by using intratubal
insemination or SIFT.
Laparoscopy often leads to an accurate diagnosis which, in turn leads to more
appropriate and specific treatment. Once the laparoscopy is over, the doctor
will usually have a good idea of what is wrong , and what can it being treated
effectively are improved now that the diagnosis is accurate.
After the laparoscopy
At the follow-up visit, discuss with the doctor what he found at the time of
the laparoscopy and also how to proceed on the basis of the findings. There are
three possible courses of action:
- Normal findings: Such findings are the commonest result and can be very
- Abnormal findings: which could be corrected at the time of laparoscopy
itself: Perhaps the doctor may suggest a second look laparoscopy or HSG
after some time to document that the problem has, in fact been corrected or
else in addition medical treatment may be advised to try to correct a
residual problem (e.g. antibiotics for pelvic infection, medical treatment
for endometriosis) A quandary may arise when the laparoscopy reveals a
finding which may be of no relevance to the problem of infertility. For
example during laparoscopy the doctor may detect small fibroids, early
endometriosis, or an ovarian cyst. These are common disorders and are often
found in fertile women as well. Just making a diagnosis of these disorders
does not automatically mean that they need to be corrected: they may be red
herrings, which do not affect fertility. In fact, unnecessary surgery to
remove these disorders can aggravate your infertility
- Abnormal findings: which could not be corrected during the laparoscopy:
For treatment, the doctor may advise formal surgery (for example
microsurgery for blocked tubes) or IVF (for example, for patients with
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani, MD.
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