What is laser laparoscopy?
Laparoscopy is the most direct and least invasive way to assess pelvic anatomy, and to proceed with laser surgery. Under general anesthesia with you completely asleep, a small telescope (the laparoscope) is inserted through the navel, through which we view your internal pelvic anatomy, and in many cases, employ laser technology to correct suboptimal conditions.
Often the chief reason for infertility or miscarriage may involve the presence of scar tissue, endometriosis, fibroids, ovarian cysts or other pelvic disorders. These same conditions may also result in pelvic pain, abnormal bleeding or other gynecologic complaints. Your laparoscopy will define whether these or other conditions involve your cervix, uterus, fallopian tubes, ovaries or entire pelvis.
More importantly, in most cases laparoscopy also provides the means for effective laser treatment of any disorder that may exist. This is critical not only in treating the problem, but also in defining the overall conditions so additional non-surgical therapies may also be considered after your surgery.
What is hysteroscopy?
Hysteroscopy involves the placement of an additional telescope (the hysteroscope) through the dilated cervix, directly into the uterine cavity (womb). No incisions are required for this, and the procedure usually takes about ten minutes. Combining hysteroscopy with laparoscopy enables an “inside and outside” view of the uterus.
Abnormalities inside the uterine cavity such as scar tissue (from prior infection or pregnancy), fibroids, polyps, or malformations can be found, and repaired at the same time, during hysteroscopy.
The recovery from a hysteroscopy alone is generally only 24-48 hours, since no incision is required. Risks are minimal, and include very low chances of bleeding, infection, or uterine perforation.
How long does the surgery usually take?
It depends on what is found, but the average laser laparoscopy/hysteroscopy takes 60-90 minutes. Following that, your recovery in the recovery room is generally 2-3 hours, and shortly thereafter you will be discharged home. In less than 1% of surgeries, admission to the hospital for observation, pain management or other reasons is necessary.
In almost every instance laparoscopy / hysteroscopy is an outpatient procedure, which means “in and out”. In instances where something is found which necessitate more involved surgery (i.e., a larger incision, which would require admission to the hospital for recovery), this more extensive surgery would not be performed unless you had specifically given consent in advance.
Are special preparations needed?
In addition to our checking preoperative blood work, there is very little else that you need to do, other than to get some sleep the night before. It is not necessary to donate blood in advance, since the likelihood of transfusion is well under 1%. You must remember to eat or drink nothing after midnight the night before surgery, although it is okay to brush your teeth the following morning with little water.
You should arrive for your surgery one hour before its scheduled time, at which time you will be greeted by the nurses and eventually by your doctor. Wear comfortable clothing, and no nail polish, so that the monitor, which the anesthesiologist will place on your fingertip, can function optimally. The person accompanying you can wait with you until minutes before the surgery is to begin, and he/she may join you in the recovery room shortly after the surgery is over.
When will the findings be known?
Immediately after the surgery, your doctor will explain to you the findings; however, you may probably not remember much of the conversation, due to the anesthesia. If someone accompanies you, and if you wish, we will explain the findings in detail and even show pictures taken during the surgery. At your post-operative office visit one week later in the office, we will again discuss everything, including the next step.
What kind of recovery should be expected?
Following laparoscopy, 3-4 days of recovery is the average time most patients need to feel basically back to normal. Some amount of abdominal pain often persists for a few days, so please take the narcotics given to you to control this pain before it gets severe, rather than letting it get to out of control. The anesthesia effect (“feeling washed out”) can also last several days. Most people return to work after 3-4 days, though there is a wide range of variation.
Do insurance companies cover the surgery?
Almost always, yes. CT Fertility insurance coordinators assist you with any questions you may have regarding insurance coverage. Each plan varies, and you need to know in advance the terms of your specific policy. Pre certification for surgery is required.