Typically, there are three areas where Laparoscopic surgery applies.
What is endometriosis?
Endometriosis is a very common condition where cells of the lining of the womb (the endometrium) are found elsewhere, usually in the pelvis and around the womb, ovaries and fallopian tubes.
It mainly affects women during their reproductive years. It can affect women from every social group and ethnicity.
Endometriosis is not an infection and it is not contagious. Endometriosis is not cancer.
For more information on Endometriosis click here
Salpingectomy – Salpingostomy
Salpingectomy refers to the surgical removal of a diseased fallopian tube. The procedure was first performed in women with a bleeding tubal pregnancy (ectopic pregnancy). Other indications for a salpingectomy include fluid-filled blocked tubes (known as hydrosalpinges). Salpingectomy is done in patients undergoing a hysterectomy (removal of the uterus) plus oophorectomy (removal of the ovary).
Salpingectomy is different from salpingostomy, a procedure where an opening is made into the tube to remove its contents, but the tube itself is not removed. The margins of the tubal incision are not sutured. It is still not clear which of the two techniques has most advantages and the least disadvantages for future pregnancy. Nowadays, with the progress in the field of minimally invasive surgery, the laparoscopic approach for salpingectomies or salpingostomies has become standard practice.
When performing a salpingectomy, it is important to bear in mind the close relationship between the tube and the blood supply to the ovary to avoid any potential damages to the ovarian function.
This is a procedure devised for the treatment of cornual occlusion or proximal tubal occlusion in women with tubal factor infertility. A tiny wire is placed through the cervix and uterus and into the tube either under x-ray guidance or via a hysteroscope. Tubal cannulation gently helps to open the tube and may relieve an obstruction in the cornual area. Laparoscopy can be performed at the same of the hysteroscopy to ensure that the tubes are not perforated with the wire and also to inject some dye through the uterus into the tubes to verify that they are open.
Laparoscopic treatment of tubal adhesions and fimbrial phimosis
Some patients with an otherwise normal fertility evaluation can have subtle adhesions over the fallopian tubes and ovaries. These adhesions appear like cobwebs (or cling-film) over the surface of these organs and can prevent the release of the egg during ovulation, prevent the tubes from picking-up the eggs and limit the motility of the tubes. Injury to the distal end of the tubes may also result in loss of or damage to the feathery appendages of the tube (fimbria), known as fimbrial phimosis. Patients at high risk for these problems include those who have had intrauterine devices for long time, those with a history of pelvic inflammatory disease (PID), appendicitis or ruptured ovarian cyst. The adhesions and the fimbrial phimosis can be treated laparoscopically (keyhole surgery).
Reversal of sterilisation
Tubal sterilisation is a common mean of birth control. The operation to reverse this permanent form of contraception is known as reversal of sterilisation or microsurgical tubal reanastomosis. The surgery employs the use of very thin microsuture to carefully put the tubes back together and is considerably more involved than the operation performed for the sterilisation.
Reversal of tubal sterilisation can be performed by laparoscopy or through a mini-laparotomy incision. If the procedure is completed by laparoscopy patients are allowed home the same day and their recovery time is much quicker as compared to mini-laparotomy, which may require up to two days of hospital stay and may restrict daily activities for a period up to four weeks.
The success of the surgery is dependent upon several factors including the length of the fallopian tube remaining after the sterilization, the use of tying, cautery or burning the fallopian tube and the expertise of the surgeon.
What you need to know about tubal surgery
If pregnancy occurs after tubal surgery there is a high risk for ectopic pregnancy (i.e. tubal pregnancy). An early pregnancy test and ultrasound scan can help confirm the site of pregnancy. Should there be uncertainty about the location of the pregnancy close monitoring in a dedicated clinic with ultrasound facilities is recommended.
Mr Gazvani is fully trained in reproductive medicine and surgery, and is one of the few skilled surgeons able to perform every kind of tubal surgery including the reversal of sterilisation by laparoscopy as a day case procedure.
The tissue reaction to any injury is known as inflammation. Depending on the type of tissue involved and the amount of damage, the tissue may be restored to normal or scar tissue may form. Tissue injury is generally the result of surgery, infection, haemorrhage (heavy internal bleeding) or trauma.
An adhesion is a thin or thick band of scar tissue that joins two or more internal body surfaces together, hence covering adjacent organs and cavities. Most adhesions are only diagnosed at the time of surgery. Adhesions that involve the uterus, ovaries, fallopian tubes, bowel and/or bladder can form and can lead to chronic pelvic pain, infertility, pain during intercourse (deep dyspareunia) and increased the risk of ectopic pregnancy.
Adhesiolysis involves cutting and releasing the adhesions in order to restore the normal anatomy of the involved organs. Treatment of adhesions can be carried out either by laparoscopy (keyhole surgery) or laparotomy (making a cut in the abdomen). Laparoscopy with gentle tissue traction, the use of non traumatic instruments and hydro-dissection (separation of the tissue using sterile water) is preferred as it appears to be associated with a lower rate of adhesions reformation. At the end of the operation, barriers can be inserted to prevent the healing tissue from sticking together with scar tissue. Barriers are like thin sheets of paper, which are gradually absorbed by the inside tissues.