Description

Endoscopic surgery

What is hysteroscopy?

As the name suggests, hysteroscopy (hystero = uterus; scopy = seeing) is the application of an
endoscope into the uterus to examine the lining on its inner surface. The
method can aid in the diagnosis of various uterine problems that can cause
infertility, such as
– Under-mucosal (internal) fibroids
– Adhesions
– Endometrium polyps
– Uterine compartments and other congenital
malformations.
Before hysteroscopy; Hysterosalpingography
(radiography showing the uterus and fallopian tubes) can be taken to obtain
information about the uterus that may be useful during surgery. Many
doctors also do vaginal ultrasonography as an assistant. Diagnostic
hysteroscopy is usually an examination performed in about 30 minutes with
general or local anesthesia.

Timing of laparoscopy

Some doctors do the laparoscopy during the pre-menstrual
period (within the week before the next period begins). As these doctors
combine laparoscopy with dilatation and curettage (by scraping the inner
surface of the uterine cavity), they learn about the ovulation status of the
woman within the same procedure.

Some doctors prefer to perform diagnostic laparoscopy combined with
hysteroscopy because it is in the post-menstrual phase where the endometrium is
thin.

Laparoscopic intervention

First of all, the abdominal skin is cleaned and properly covered. Then, an
instrument can be inserted through the vagina and into the uterus. Carbon
dioxide, nitric oxide or air is introduced into the abdominal cavity, just
below the belly button. The gas given creates a space that separates the
abdominal wall and intestines from the organs in the pelvis, making it easier
to see the reproductive organs.

Laparoscopy, a thin tube resembling a miniature sailor’s sight, is inserted
through an incision made just below the navel. With a second probe
inserted into the abdominal cavity through another incision, the pelvic organs
are given positions where they can be seen better. A diagnostic
laparoscopy performed without drilling this “second hole” is not
complete, since it is not possible to see all the formations completely when
the probe is not used.

During laparoscopy, the whole pelvis is scanned and organs – uterus; The
ovaries and the covering (peritoneum) covering the inner surface of the abdomen
are systematically examined by direct inspection. The doctor also looks
for the presence of adhesions (bands), endometriosis and tubercles as well as
the diseases that may occur in these formations. If there are any
abnormalities, the doctor; He either tries to correct them (operative
laparoscopy) or, using a biopsy forceps, takes small pieces of tissue (biopsy)
for examination in the pathological examination. A blue dye (methylene
blue) is then injected into the uterus and fallopian tubes to see if they are
open. When the laparoscopy is complete, the gas that has been introduced
is drained and one or two stitches are placed to close the
incisions. Since the incisions made are very small,

As mentioned earlier, some physicians perform laposcopy along with dilatation
and curettage and send fragments obtained from the endometrium for histological
examination to rule out the possibility of latent tuberculosis; it also
investigates whether ovulation has occurred. Others perform diagnostic
hysteroscopy at the same time as laparoscopy to make sure the uterine cavity is
normal.

Most of today’s doctors use video laparoscopy technique, in which a video
camera is attached to the laparoscope, allowing what the surgeon sees on a TV
monitor. This type of laparoscopy also greatly aids patient education by
allowing doctors to show video or CD recordings to the patient later to explain
the nature of the current problem.

Recent advances that have made the devices ever smaller have enabled the
construction of very small laparoscopes. These laparoscopes, which are the
thickness of a needle, are called microscopes or needle scopes. These
miniature laparoscopes allow laparoscopy to be performed in the office without
the use of anesthesia. However, the quality of the images obtained with
these small laparoscopes has not been improved yet.