According to statistics, most often women turn to the gynecologist with the problem of infertility. Infertility is understood as the inability to conceive throughout the year with regular (at least 2 times a week) unprotected sexual intercourse.
Infertility happens:
For adequate treatment, it is extremely important to establish the cause of infertility. Often this is done through surgery. Such a low-traumatic operation is laparoscopy.
Types of intervention and indications for carrying out
There are the following types of laparoscopy:
Indications for laparoscopy can be planned and emergency.
Planned indications include:
Emergency laparoscopy is performed in such conditions as:
In addition, emergency surgery is used to differentiate acute gynecological diseases from surgical pathologies.
Preparation and conduct of the intervention
Most often, laparoscopy is performed after menstruation, since during this period doctors are best able to assess the condition of the reproductive organs, but sometimes surgery is performed before menstruation. This should be decided by the attending physician.
Before carrying out laparoscopy, a number of tests are prescribed:
In addition, a certificate from the therapist and gynecologist is required that there are no contraindications to surgical intervention. A few days before laparoscopy, you need to stop taking certain medications, such as Acetylsalicylic acid, Ibuprofen.
The last meal should be at least 8 hours before surgery. But most often it is recommended to have the last meal at 18:00, and water - at 22:00, on the eve of the operation.
Jewelry, contact lenses, glasses, dentures, and bridges should be removed before surgery.
Sometimes the doctor prescribes a cleansing enema and the intake of enterosorbents, since the swollen intestine interferes with the surgical intervention, and it can be easily damaged during laparoscopy.
How is the operation going?
At the request of the patient, the operation can be performed both under general and local anesthesia. The cost of laparoscopy in Moscow and St. Petersburg can vary significantly depending on the clinic and varies from 8 to 80 thousand rubles.
Contraindications, limitations to conduction and consequences
Many contraindications to laparoscopy are relative and depend on the skill of the surgeon, as well as on the equipment with which the operation will be performed.
But there are absolute contraindications to laparoscopy, such as:
Relative contraindications include:
It is also worth postponing a planned operation if:
Postoperative complications
Despite the fact that laparoscopy is a low-traumatic operation, complications can also develop after it, which can not only worsen a woman’s health, but also lead to death.
These can be complications, as with any other surgical intervention, for example:
But there may be specific complications that are characteristic only for laparoscopy.
Laparoscopy for infertility is one of the most modern methods treatment of this pathological condition. Most often, such surgical intervention is used in the tubal-peritoneal form of fertility disorders. The task of laparoscopic surgery is to restore the patency of the fallopian tubes, through which a fertilized egg normally moves.
Indications
Indications for laparoscopy in infertility look like this:
- Tubal-peritoneal infertility is the most common indication;
- Polycystic ovary syndrome, which is characterized by a significant thickening of the tunica albuginea. In this case, the egg cannot leave the follicle into the abdominal cavity, and therefore fertilization becomes impossible;
- Difficult diagnostic cases when it is not possible to identify the cause of infertility. In this situation, it is shown diagnostic laparoscopy.
Before the appointment of surgical intervention, it is necessary to make sure that the diagnosis is correct. Infertility in women is established in the absence of pregnancy for a year or more, if contraceptive methods are not used and regular sex life is conducted.
Laparoscopy for tubal-peritoneal infertility is indicated for:
- Previously transferred operations on the pipes;
- Inflammatory processes that disrupt the normal anatomical structure and the relationship of the pelvic organs;
- Congenital anomalies in the development of the fallopian tubes.
The essence of the procedure
Laparoscopy - what is it and how is it carried out? The first step is adequate anesthesia. Most often, intravenous anesthesia is performed with a complete shutdown of consciousness. Conducting spinal and epidural anesthesia is limited due to the ongoing compression of the diaphragm, which entails a corresponding respiratory failure.
At the second stage, therapeutic and diagnostic laparoscopy involves the imposition of pneumoperitoneum, that is, the introduction of gas into the abdominal cavity. This will allow you to “spread” the organs, in order to avoid injury, improve visualization and access to the fallopian tubes.
The third stage is the introduction of instruments and the actual intervention on the fallopian tubes. Most often, plastic surgery is performed. Their essence lies in the removal of the scar-modified area and the accurate stitching of the ends of the fallopian tubes. Sometimes it is enough to cut the adhesions that compress the lumen of the organ. If laparoscopy is performed for polycystic ovaries, then at this stage their wedge-shaped resection is performed (an incision in the cavity of cystic formations). In the postoperative period, such women are advised to have an active sex life for the early onset of pregnancy.
In the case of a diagnostic operation, a thorough revision of the pelvic organs is performed with the determination possible cause infertility. This can be the uterine form of the disease (with abnormalities in the development of the uterus), ovarian (with polycystic ovaries), tubal-peritoneal (in the presence of adhesions and cicatricial deformity of the fallopian tubes).
Thus, laparoscopy for unexplained infertility allows you to clarify the cause of the disease by exclusion, and in other cases - to treat the existing pathological process. As a result, this will restore the normal fertility of a woman.
Possible contraindications
For a successful operation, it is necessary to take into account possible contraindications, which may be temporary or permanent. After their elimination (this applies to temporary ones), it is possible to perform this minimally invasive surgical intervention.
The main contraindications include the following:
- Acute or exacerbation of a chronic inflammatory process of the female genital organs;
- General infectious disease (acute respiratory infections, intestinal infections);
- The absence of a standard examination before the operation, which will determine the state of the woman's body;
- Arterial hypertension, which is not controlled by medication;
- Blood clotting disorders, etc.
Consequences of the operation
In most cases, laparoscopy is well tolerated. However, in some cases, typical postoperative complications may develop, which include:
- Bleeding (as a result of slipping of the ligature from the vessel or as a result of lysis of the formed thrombus);
- The development of the inflammatory process in the pelvic organs;
- The ineffectiveness of the operation as a result of the repeated development of the adhesive process (most often this is noted in persons with a genetic predisposition to the synthesis of a certain type of collagen).
Consequences of laparoscopy during pregnancy minimal. As a rule, the course of the gestational period does not suffer. However, in order to avoid the development of the threat of abortion, it is necessary with preventive purpose take antispasmodic drugs for 10-14 days. In addition, the consequences for the child largely depend on the type of anesthesia used. Therefore, pregnant women are advised to replace general anesthesia with regional anesthesia techniques (spinal and epidural analgesia). They have minimal impact on the developing fetus.
In conclusion, it should be noted that laparoscopy in the treatment of infertility successfully used in case of obstruction of the fallopian tubes. With its help, it is possible to restore the normal lumen of the organ, which ensures the unhindered movement of spermatozoa until they meet with the egg. Somewhat less often, laparoscopy can be used in the treatment of polycystic ovary syndrome.
However, in order to achieve the best results from surgical treatment, it is necessary to take into account possible indications and contraindications, which will avoid complications and negative results.
The diagnosis of "infertility" in most cases already sounds like a sentence. But if the words “infertility of unknown origin” are added to it, then this already seems like a tragedy. Yes, earlier in 50% of cases this diagnosis was made, if other causes of occurrence were not clarified this disease.
But times are changing, and medicine does not stand still. IN last years infertility of unknown origin has become less frequent in the anamnesis of patients. Statistics show that in the past few years, idiopathic or unexplained infertility has been detected in only 10% of cases. And this is more encouraging. But what to do if such a diagnosis appeared in patients?
Yes, it is in patients, since the examination is carried out on two fronts. Not everyone knows, but there is not only female infertility, but also male infertility, and therefore both spouses will have to undergo diagnostics. Treatment in this case is prescribed only for certain indications.
Idiopathic infertility is detected only if all the causes known to medicine have not been found. That is, if any deviation from the norm was not recorded, all factors indicate that the patients are absolutely healthy, but they nevertheless cannot conceive a child, then this is unexplained infertility.
Pregnancy may not occur for various reasons, but among the indications for this disease, problems with:
- The regularity of the phases of ovulation;
- The cyclicity of the menstrual cycle;
- Uterus;
- Endometrium (most often infertility occurs with endometriosis);
- The hormonal background of a woman.
It is still easier with men, most often the causes of infertility due to the fault of the stronger sex are:
- Sedentary spermatozoa;
- Small number of spermatozoa;
- Problems in the passage of spermatozoa through the seminiferous tract.
And it is also possible the appearance of such an indication for the impossibility of pregnancy, as the incompatibility of partners. This is due to the fact that a woman has antibodies that destroy spermatozoa, mistaking them for foreign and harmful bodies.
But if none of these causes has been found, then unexplained infertility is diagnosed.
Laparoscopy
Laparoscopy is one of the methods for diagnosing this disease. Translated from Latin, this word means "look at the stomach." This type of surgical intervention is performed without an incision, but allows you to see the condition of the internal organs of a woman. Through the use of special optical devices a specialist in the field of gynecology examines the organs, trying to identify abnormalities. Among other things, laparoscopy in most cases does not require a second procedure, since the first time it copes with pathologies perfectly. Or secondary treatment is not required, because it becomes clear that it will not bear fruit.
This method of surgery allows the patient to recover quickly enough, and also has almost no chance of injuring the woman during the operation.
After this procedure, no scars remain on the patient's body, which usually appear during abdominal operations. Laparoscopy is prescribed only for certain indications.
The diagnostic method itself allows you to make a diagnosis with absolute certainty, which is simply an incomparable plus. This procedure must be performed under intubation anesthesia. The laparoscope, which is used for this event, is a thin metal tube, the diameter of which ranges from 5 to 10 mm.
In addition to all of the above, laparoscopy for infertility has a number of advantages that favor its implementation. Through the use of this diagnostic method, the slightest causes for the onset of the disease can be identified. In addition, the laparoscope magnifies the lesion dozens of times and shows it in great detail, which subsequently also helps to remove the damage most accurately and with the precision of a jeweler, which is simply necessary for such events. With the usual kind of operations, such precision of manipulations is impossible.
Among the indications, the most common are certain infectious diseases that harm the normal functioning of the organs.
This method of surgery is divided into three types:
- Diagnostic laparoscopy, in which a visual examination of the woman's organs is performed using another, additional manipulator. It is carried out to check for the presence of any disease previously established. That is, if a violation of the patency of the fallopian tubes is detected, a gynecologist may offer to check his guess through laparoscopy.
- Operative laparoscopy is performed in case of direct treatment of the disease. Usually, such causes of infertility as endometriosis, uterine fibroids, etc. are eliminated. Surgical intervention is carried out with the aim of not only examining organs for the presence of pathologies, but also with the aim of their simultaneous destruction. At the same time, healthy tissues remain intact, which acts as another plus of this operation.
- Control laparoscopy is carried out in order to examine the organs after the treatment in order to identify the consequences of the disease.
Causes of infertility that can be identified and removed by this surgical method:
The operation itself is carried out either after the end of the regulation, or a couple of days before them. The best time for this procedure is the period of ovulation.
Before the operation, it is worth remembering about protection during sexual intercourse. Moreover, contraceptive methods should not affect the hormonal background of a woman, and therefore you should not use contraceptives. It is worth protecting yourself with the help of condoms, which in turn can protect against infection.
With the help of laparoscopy, diagnostics and a detailed examination of the abdominal organs are carried out. This special kind surgical intervention, during which no incision is made, and the patient stays in the hospital for only three days. The advantages of this method are that this diagnosis is close to one hundred percent, and also, after the operation, there are no scars left in the woman's body. During the operation, intubation anesthesia is used.
A laparoscope is a tube made of metal, which is about ten millimeters in diameter, which transmits an image of the internal organs to the screen, and all pathologies become visible. After all, it is thanks to the laparoscope that you can enlarge the picture ten times, and in this case it is possible not only to detect pathology, but also to get rid of it without affecting the internal organs.
Types of laparoscopy
- Control. This operation is performed for the second time, after the already existing surgical intervention, in order to verify the effectiveness of the previously performed procedure.
- Operational. This species captures many gynecological operations, and treats diseases such as endometriosis, cysts, infertility, uterine fibroids, ectopic pregnancy.
- Diagnostic. This is a type of laparoscopy in which organs are examined using a spare manipulator. After all, it is the diagnostic type of laparoscopy that can either confirm or refute the alleged diseases.
What does laparoscopy treat?
- endometriosis- this is the spread of uterine tissue beyond its borders, which is abnormal. And the most difficult type of endometriosis is precisely the abdominal one, which is located throughout its cavity. And due to endometriosis, adhesions in the uterine appendages may occur.
- uterine fibroids diagnosed in women who have impaired hormone production. It is a benign tumor that menstrual cycle women and is usually asymptomatic.
- Adhesions in the pelvis- these are the so-called small "threads" that appear as a result of inflammation and operations. It is the fallopian tubes that are most susceptible to the formation of adhesions. There are four types of adhesions that always lead to the fact that the relationship between the fibrias of the tube and the ovaries is disturbed.
- ovarian cyst- this is a "growth" outside or inside the ovary. So, functional cysts are eliminated by themselves, with organic ones, which leads to rupture of the ovary, it is necessary to address it quickly and operatively.
- Fallopian tube patency- this is when its lumen narrows, and it is more and more difficult for the sperm to get into the egg, and it is more and more difficult for the egg to get into the uterus through the fallopian tubes. And often this is the cause of infertility.
Survey
Before the operation, such tests are taken as: blood biochemistry, complete blood count, blood for sugar, HIV, blood group and Rh factor tests, hepatitis, urinalysis and ECG, chest x-ray, ultrasound, smear.Seven days before surgery, doctors advise you to stick to a diet that should remove foods that will disrupt bowel function.
Still need to stop taking medication. And immediately before the operation, it is necessary to carry out a bowel cleansing procedure so that the doctor can easily see all the necessary organs.
At the first stage of the operation, the doctor makes a diagnosis of the disease, and during the treatment, or the second stage, the doctor removes or eliminates all possible pathologies. Thanks to intubation anesthesia, the patient does not feel anything.
After laparoscopy, there may be chest pain caused by carbon dioxide, which inflates the abdomen and compresses the diaphragm, and there may also be pain in the throat through which the patient breathes.
And in the postoperative period, the patient does not have a strict diet, and for several weeks it is not allowed to take a bath so that the seams do not open. Moderate physical activity is recommended to engage in, but sex only after three weeks.
Of the negative consequences that may occur after surgery, there may be - hernia, violation of internal organs, damage to the vessels of the abdominal cavity, subcutaneous emphysema, pneumothorax, etc.
Modern medical technologies strive to obtain more accurate data in the least traumatic way. In the fight against infertility, couples who want to conceive undergo many procedures and, the totality of the results of which allows us to outline a treatment plan. Laparoscopic surgery occupies a leading position in the detection of reproductive disorders in women, as it allows a thorough examination of the pelvic organs with minimal discomfort for the expectant mother.
The causes of infertility in women can be factors of various origins: psychosomatic disorders, endocrine system disorders, pathologies of the reproductive organs, abnormal cycle, etc. Laparoscopy is one of the most common methods for diagnosing and treating possible disorders.
What it is
The procedure is a minimally invasive surgical intervention through punctures in the abdominal cavity using a laparoscope.
The device is an optical system with a camera, magnifier, lighting lamps.
Through other punctures, the instruments necessary for manipulation are introduced. The area of introduction of special tubes does not exceed 1.5-2 cm, which allows the body to recover quickly.
The operation is considered low-traumatic, but requires high qualification of the doctor conducting it. In gynecology, laparoscopy is used to diagnose, treat disease, and monitor outcomes.
Diagnostic laparoscopy
Laparoscopic operations differ in the purpose of the procedure for diagnostic, operative, control. Diagnostic laparoscopy is performed to clarify the condition of the internal organs of the abdominal cavity.
Often, the symptom of "acute abdomen" is difficult to associate with a specific disease, and laparoscopy allows you to make an accurate diagnosis, then choose a further treatment strategy. Diagnostic surgery is prescribed if the desired pregnancy does not occur, subject to the regimen of sexual activity, in the absence of deviations that affect the success of conception.
Clarifying laparoscopy can reveal both the cause of infertility and detect inflammation and pathology not related to the reproductive system.
During the procedure, the doctor can both examine the fallopian tubes and restore their patency in case of minimal adhesions.
Kinds
An operative type of procedure is a surgical intervention to eliminate the identified disease.
The indication for surgery is an established diagnosis (fibroids, ovarian cysts, endometriosis, ectopic pregnancy, etc.). During the procedure, the doctor carefully analyzes the data of a comprehensive examination of the internal organs, then decides on the removal or correction of the pathology.
Control laparoscopy is used less frequently than the other two types. Its purpose is to monitor improvements after a previous procedure. When planning a pregnancy, a control study is prescribed at the end of a course of hormone therapy to track the results of a previous surgical intervention.
Also, the procedure is divided into planned and emergency, depending on the time of implementation.
Should I do an ovarian laparoscopy?
Laparoscopy is most widely used in the fight against polycystic ovaries.
Identification of the syndrome by a doctor does not always require surgical intervention, options are possible conservative treatment hormonal drugs.
However, cysts big size or an atypical shape must be removed, for which laparoscopy is the optimal procedure.
Compared to open surgery, the laparoscopic procedure has several advantages:
- Less invasive (minimal tissue damage, no profuse blood loss).
- Preservation of healthy functioning of the ovary (at 40x magnification, the difference between healthy tissue and neoplasm is more easily seen).
- Less risk of complications.
- Short rehabilitation period (only 3-4 days).
- A tiny scar at the site of intervention (the scar remains invisible, in the navel area under the skin fold).
It is impossible to carry out the operation if there is at least one contraindication: acute infection, oncology, blood clotting disorders, obesity of 3 or 4 degrees.
Definition of unclear genesis in gynecology
In 80% of cases, laparoscopy is performed to determine the unclear genesis of infertility. This means that preliminary tests could not establish the exact cause of the inability to conceive.
With primary infertility (no history of pregnancies), laparoscopic examination reveals chronic inflammatory processes that interfere with fertilization.
When (the presence of a confirmed pregnancy in the anamnesis with subsequent complications in the form of injuries, fading, abortion), a minimally invasive operation provides accurate information about the degree of organ damage, which makes it possible to establish the nature of the failure in the body. In this case, the treatment will be aimed at restoring and maintaining the functions necessary for conception. In the future, the completed course of therapy should be completed with a follow-up laparoscopy.
