Endoscopic surgery

The endoscopy is defined as the direct observation of the inside of an organ or cavity by means of an optical method or endoscope (illumination tube connected to a video camera and television device), which is introduced through the natural orifices or through the abdominal wall. Therefore, we obtain the information in a more reliable way than the information given by other external explorations, such as physical tests, ultrasound scans or radiology techniques.

By using it, we make sure the best output and reliability in the interpreting of the images, minimizing the risk of any complication. The endoscopic techniques allow a correct diagnosis and treatment of the gynaecological pathologies in a less aggressive way, which is extremely important in the surgical treatment of the reproductive problems.

Only a few hours of being hospitalized are necessary, allowing the patient to go back home the same day of the intervention. The post-operatory feelings of discomfort are lower than with conventional surgery, which means that the patient does not have to modify substantially the job and social daily activities, while maintaining the effectiveness of the intervention.

Endoscopic surgery also provokes a lower haemorrhage and blood loss, at the same time that reduces the adhesions. Besides, the aesthetic results with endoscopic techniques are much better that with the open conventional surgery.

Due to all these reasons, the endoscopic surgery is indicated and reliable, being the surgery technique chosen.

Laparoscopy

This is carried out under general anaesthesia, that is why before the intervention it requires a preoperatory research and an assessment by the anaesthesiologist. It consists of the introduction of CO² in the abdominal cavity by means of a needle inserted through the abdomen at the navel level. Once the distension of the abdominal cavity is achieved, the trocars or guides of 5 and 10mm are introduced, through which the surgical tools are located (optics, pressure forceps, scissors, coagulators, etc).

In the fertility research cases a movilizator is placed in the inside of the uterus, through the vagina. Through this movilizator a methylene blue contrast is introduced in order to confirm the permeability of the Fallopian tubes.

The laparoscopy goal is double: on one hand to diagnose and on the other, to solve those problems detected during the intervention.

Amongst the indications for using laparoscopy, we indicate the following:

  • Fertility research.
  • Diagnosis of the uterine malformations.
  • Unexplained pain or pelvic algia.
  • Bilateral tubal sterilization (tubal ligation).
  • Endometriosis.
  • Cysts and ovarian mass.
  • Ectopic pregnancy.
  • Ooforectomy (ovary extirpation).
  • Myomectomy (myoma extirpation).
  • Salpingectomy (extirpation of the pathological tubes).
  • Ovarian drilling (polycystic ovary).
  • Hysterectomy (uterus extirpation).

After 48-72 hours patients can go back to their daily activities.

Diagnostic hysteroscopy

It consists of the introduction of a small-bore optic through the vagina and neck of the uterus. Thanks to the infusion of physiological serum the endometrial cavity is expanded, achieving a good visualization thereof.

At the same time, it allows the taking of selective biopsy under direct visual control if it is considered appropriate. Patients do not need to be hospitalized and the intervention is carried out without anaesthesia or sedation being necessary. It does not last longer than 5-10 minutes and after it, patients can go back to their daily activities.

Since this procedure can cause feelings of discomfort, similar to the menstrual pain, a previous preparation with muscle relaxant and analgesics is carried out.

The main indications of ambulatory diagnostic hysteroscopy are the following:

  • Suspicion of uterine adhesion.
  • Suspicion of endometrial polyps.
  • Suspicion of submocous myomas.
  • Suspicion of uterine septums.
  • Extraction of strange substances and IUD.
  • Infertility research and implantation failures.
  • Research of menstrual alterations.
  • Research of endometrial cavity previous to the assisted reproductive treatments.

Surgical hysteroscopy

It requires general anaesthesia (sedation) or local anaesthesia, since it is necessary to expand the neck of the uterus; that is why a pre-operatory research and an assessment by the anaesthesiologist are conducted.

It solves most of pathologies diagnosed by the ambulatory hysteroscopy and also the ones suspected by other image techniques (ultrasound scan, hystero-salpingography, hystero-sonography, NMR, etc.).

Technically, it consists of introducing an optical cable and a surgical tool at the same time through the opening to the cervix, and this allows the use of small scalpels, coagulation systems (roller), etc, operated by an electrical motor.

Complications occur infrequently, and in general, they are rarely serious, so it is becomes a very safe technique, and it is a satisfactory way of dealing with the intrauterine problems. It is usually possible for the patient to go back home the same day of the intervention. Physical activities, bathing and sexual relationships are not allowed for the following period of 5-7 days.

The main indications for the surgical hysteroscopy are the following:

  • Septoplasties.
  • Myomectomies.
  • Polypectomies.
  • Ablation- reduction of endometrial.
  • Release of adherences.

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