Laparoscopy

Micro laparoscopy is a minimally invasive diagnostic surgical procedure. Laparoscopy enables the surgeon or a gynecologist to directly view the organs of the abdomen and pelvis. Laparoscopy minimizes hospital stay after surgery and recovery period too. Laparoscope is an instrument in the shape of a miniature telescope with a fiber optic system. The laparoscope is a sterile surgical instrument, which has special optics that allows small amounts of light to be transmitted effectively. A laparoscopy involves two cuts approximately 5 -10 cm long. The first cut is below the navel. A hollow needle is inserted. Carbon dioxide gas is pumped into the abdomen through this channel in the laparoscope. This is done to create a space within which the surgeon can look or operate.

The laparoscope is inserted through a second small cut made on the abdomen. The exact position depends upon the procedure that is being conducted. The laparoscope can be moved around within the abdominal or pelvic cavity to give several different views to the operating surgeon. At the end of the procedure, the instruments are removed and the carbon dioxide gas is allowed to escape and the cuts closed with stitches.

• Laparoscopy is used to check infertility. It is used for sterilization in women. It is also used to check ectopic pregnancy, causes of pelvic pain and masses.
  
• Laparoscopy is used to diagnose causes of abdominal pain.
  
• Laparoscopy helps to detect the presence of endometriosis.
  
• The adhesions caused by abdominal scar tissue are separated by laparoscopic procedure.
  
• Laparoscopy can diagnose fibroids.
  
• Ovarian cysts can be identified with a laparoscope.
  
• Laparoscopes assist in vaginal hysterectomy.
  

Hysteroscopy

Hysteroscopy is a diagnostic test that makes use of a thin telescope-like hysterescope to view and operate upon the endometrial cavity. Carbon dioxide is filled into the cavity to aid this process. While often hysteroscopy can be done as an outpatient procedure, some women may need local anesthesia. In some cases, hysterescopy is done along with a resectoscope. But this procedure destroys the uterine lining and is not a viable alternative for women who wish to have children. A laparoscope may be used to view the uterine exteriors.

Diagnostic hysteroscopy involves observation of the endometrial cavity for any abnormalities. This procedure is often used in cases where there has been abnormal uterine bleeding or repeated miscarriage. Diagnostic hysteroscopy may also be used to confirm the results of HSG. Hysterescopy may be used to check for causes of heavy or irregular menstrual cycle or fit IUD.

Operative hysteroscopy involves use of hysteroscope to remove polyps, cut adhesions or treat fibroids and septums. This can be used as an alternative to open abdominal surgery. This involves use of operative hysteroscope that allows the physician to insert operating tools. In rare cases, hysterescopy may lead to infection and heavy bleeding or injury to the cervix or uterus.

Pomeroy technique

Named after Dr. Ralph Pomeroy, Pomeroy technique is a process of tubal ligation i.e. removal of a portion of the fallopian tube. It is a sterilization procedure for women devised by Dr. Ralph Pomeroy at the end of the 19th century and start of the 20th century. This procedure is still popular as it is an effective yet simple method to block the fallopian tubes.

The Pomeroy Technique

The technique adopts a simple yet effective procedure for tubal legation.

• In this technique, part of the tube (proximal portion of the tubal ampulla) is elevated so as to create a loop or a knuckle.
  
• An absorbable ligature (suture material) is tied around the base of the elevated part, and the tubal segment is cut out.
  
• Within a few days, the peritoneum, i.e. tissue that lines the organs of the abdominal cavity, grows and covers the severed ends of the tubal section.
  
• As the ligature dissolves, the severed ends of the fallopian tube separate from one another.
  
• The fallopian tubes remain separate without reattaching because of the above mentioned separation and the peritoneal covering.
  
• Eggs cannot travel down the separated fallopian tube, and so the woman does not get pregnant.

Variations of the technique include the following. These variations determine the length of the tubal segment that can be repaired from the remaining tube.

• Length of the tube that is tied up and cut.
  
• Location of the tube where it is going to be tied and cut.
  
• Number of ligatures placed around the tube.
  
• Type of ligatures placed around the tube.
  
• If the cut ends are crushed or coagulated.

There are many advantages of the modified Pomeroy technique. In rare cases, the severed ends drift back together and heal, or the suture does not dissolve and the fallopian tube becomes connected again.

The Pomeroy procedure is:

• Simple to perform
  
• Highly effective depending on the length of the tube removed
  
• Pomeroy ligation technique leaves two healthy segments of the fallopian tube which can be rejoined, if required through a tubal legation reversal surgery.
  
• Successful reversal rates are quite high; about two thirds of the women become pregnant following reversal of this procedure.
  
• Prior to tube reversal, the length of the tube that has been removed can be determined from the tube legation report.
  
• Procedure can be performed vaginally, abdominally or through laparoscope.
  
• Minimal complications.