Laparoscopy ( also called endoscopy or pelviscopy) is a surgical procedure in which a telescope is inserted inside the abdomen through a small cut below the navel, so that the doctor can have a look at the pelvic organs in the infertile woman. A laparoscopy can lead to the diagnosis of many problems which cause infertility including damaged tubes, endometriosis, adhesions and tuberculosis.

Laparoscopy (pronounced "lap-a-ROSS-coe-pee") is a surgical procedure performed through very small incisions in the abdomen, using specialized instruments. A pencil-thin instrument called a laparoscope is used, and it gives the surgeon an exceptionally clear view, on a TV monitor, of the inside of the abdominal cavity.

When is laparoscopy done?
In the past, a diagnostic laparoscopy was a routine part of the workup in infertile women, in order to complete their evaluation. Generally, the procedure was performed after the basic infertility tests were done, since it is a surgical ( invasive) procedure. Today, however, the utility of laparoscopy in treating infertile women is very limited, and we rarely perform laparoscopies in our clinic.

Timing the surgery
Some doctors will time the laparoscopy during the premenstrual phase (the week before the next period is due). They combine the laparoscopy with a dilatation and curettage (D & C) (scraping the inside of the uterine cavity) so that they can also get information on the woman's ovulatory status in the same procedure.
Some doctors try to perform the diagnostic laparoscopy during the post-menstrual phase, when the uterine lining is thin, so that they can combine it with a hysteroscopy at the same time.

How is the laparoscopy performed ?
The laparoscopic procedure First of all, the abdomen is cleansed and draped for the procedure. Then an instrument may be placed in the uterus through the vagina. A gas, such as carbon dioxide or nitrous oxide or air is then allowed to flow into the abdomen just below the belly button. This gas creates a space inside by pushing the abdominal wall and the bowel away from the organs in the pelvic area and makes it easier to see the reproductive organs clearly.

The laparoscope, which is a slender tube, like a miniature telescope, is then inserted through a small incision just below the navel. During the laparoscopy a small probe is placed through another incision in order to move the pelvic organs into clear view. A diagnostic laparoscopy is incomplete without a "second puncture" because, without this second probe, it is not possible to visualize all the structures completely.

During the laparoscopy the entire pelvis is carefully scanned and the organs inspected systematically - the uterus; the ovaries; and the lining of the abdomen, called the peritoneum. In addition to looking for diseases affecting these structures, the doctor also looks for adhesions (bands of scar tissue), endometriosis and tubercles. In case abnormalities are found, the doctor can either try to correct them (operative laparoscopy), or take out bits of tissue for histologic examination (biopsy) with a biopsy forceps. A blue dye (methylene blue) is then injected through the uterus and fallopian tubes to check whether the tubes are open. When the surgery is complete, the gas is removed and one or two stitches inserted to close the incisions. Since the incisions are so small, often stitches are not needed and they can be closed with Band-Aids.

Possible Complications of Laparoscopy

• Risks for any type of surgery may be greater for people who are obese, smoke cigarettes, or have additional health problems.
   
• Laparoscopy usually requires general anesthesia, which carries certain risks. Modern general anesthesia, however, is safe and reactions are rare. The individual must be sure to tell the doctor if he or she had a bad reaction to anesthesia in the past, or if a close family member has experienced such a reaction.
   
• Injury to blood vessels or organs, which causes bleeding.  Damage to ducts or other structures that allow body fluids to leak out.

Sometimes the surgery cannot be successfully completed by laparoscopy. Then the doctor may have to complete the operation using traditional "open" abdominal surgery, called laparotomy. This is called "converting" to laparotomy.

How Long Will It Take For Full Recovery?
Recovery time depends on the kind of procedure, the patient's age, and health before the procedure. The following is a normal timetable for recovery from minimally invasive surgery on the abdomen:

• The groggy feeling from the anesthetic disappears the day after surgery and the individual is fully alert once again.
   
• Any pain in the shoulders or neck area usually goes away after a few days.
   
• Soreness in the incisions disappears within a few days and the incisions heal after about five days.
   
• The bloated feeling after abdominal or pelvic laparoscopy goes away within a few days.