Laparoscopy is a procedure used in the diagnosis and management of problems in gynecology including infertility. It is performed using an instrument called the laparoscope, which is a slender miniature telescope with a light source. It enables visual inspection of the pelvis and abdomen. Laparoscopy is a fairly safe and simple day-care procedure.

Uses:

• Detection of abnormalities in any of the pelvic organs (uterus, tubes and ovaries).  Examples - endometrioses, uterine fibroids and presence of adhesions in the pelvis.
• Diagnosis of unexplained pelvic pain.
• Removal of an intrauterine contraceptive device (e.g.: Cu-T) that has entered the abdominal cavity from the uterus.
• Assess patency of the fallopian tubes, i.e. notes whether the tubes are open or blocked.

Generally laparoscopy does not form the first line of investigation in infertility.

Cntraidications

• Pregnancy
• Infection in the abdomen or pelvis.
• Severe heart disease
• Relative contraindications are obesity (>100kg) and previous multiple abdominal surgeries.

 Procedure

• Prior to the procedure the woman is required to undergo some blood and urine tests to confirm that her general health is good.
• The woman comes in the morning after an overnight fast.
• Laparosocpy is better performed under a short acting general anesthesia.
• The woman is appropriately positioned and the procedure is carried out under aseptic precautions.
• A small nick is made below the umbilicus through which a special slender needle is inserted into the abdominal cavity. Carbon dioxide is passed through the needle in order to distend the abdomen and move away the bowels, for easy visualization of all the organs.
• The needle is removed and the laparoscope is introduced through the same incision. The uterus, tubes, ovaries and the pelvis are visualized through the laparoscope.
• The dye test is carried out with the laparoscope still in place.
  
  -         Distilled water mixed with a few drops of a dye called methylene blue is slowly instilled into the uterus through a cannula or hollow tube passed into the uterine cavity via the vagina and cervix.

Operative procedures can be performed by the introduction of accessory instruments into the abdominal cavity in a manner similar to the introduction of the laparoscope. These instruments either cut or burn tissues. The proceedings are monitored on a screen by means of a video camera attached to the laparoscope. Procedures that can be performed are:

After care

• The patient is given antibiotics to prevent any infection, and analgesics to relieve pain.
• Oral intake is begun 2-4 hours later.
• The patient is allowed to leave 4-6 hours later.
• There may be pain in the shoulders or a sensation of bloatedness due to remaining gas in the abdomen. This settles within a day or so as the gas is slowly absorbed.
• Normal work may be resumed after 2-3 days of rest.

Complications are rare. They include:

• Accidental entry into a blood vessel or bowel or any of the pelvic organs. The problem can be managed by opening the abdomen (laparotomy) and repairing the defect.
• Entry of air into a blood vessel and thence into the blood circulation, what is termed as embolism. This is an emergency and requires intensive care.
• Infections