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Laparoscopy and Hysteroscopy
Minimally invasive endoscopic examination of the pelvic organs and uterine cavity to diagnose and treat conditions including endometriosis, fibroids, ovarian cysts, and intrauterine pathology.
Overview
Overview
Laparoscopy and Hysteroscopy are complementary minimally invasive endoscopic surgical procedures that allow direct visualisation and therapeutic treatment of conditions affecting the uterus, fallopian tubes, ovaries, and peritoneum through the smallest possible surgical access. Laparoscopy is performed through small abdominal incisions using carbon dioxide gas insufflation to create an operating space for the camera and surgical instruments. Hysteroscopy is performed through the natural cervical opening to inspect and treat the inside of the uterine cavity. Both procedures combine diagnosis and surgical treatment in a single operative episode, significantly reducing recovery time and hospital stay compared to traditional open surgical approaches.
Types of Laparoscopy and Hysteroscopy
- Diagnostic laparoscopy — direct inspection of the pelvic organs to definitively diagnose endometriosis, pelvic adhesions, or unexplained pelvic pain
- Operative laparoscopy — keyhole surgical treatment of endometriosis deposits, ovarian cysts, ectopic pregnancy, uterine fibroids, or pelvic adhesions
- Laparoscopic sterilisation — permanent contraception by bilateral salpingectomy (tube removal) or tubal occlusion by clips
- Diagnostic hysteroscopy — direct uterine cavity inspection for polyps, submucosal fibroids, intrauterine adhesions, or abnormal endometrium
- Operative hysteroscopy — resection of endometrial polyps, submucosal fibroids, or intrauterine adhesions, or endometrial ablation under direct vision
Risk Factors of Laparoscopy and Hysteroscopy
- Suspected or confirmed endometriosis with chronic pelvic pain, dysmenorrhoea, or subfertility unresponsive to medical management
- Ovarian cyst requiring surgical characterisation, drainage, or cystectomy not achievable by watchful waiting and medical treatment alone
- Confirmed ectopic pregnancy requiring surgical management by laparoscopic salpingotomy or salpingectomy
- Post-menopausal or intermenstrual bleeding with suspected intrauterine pathology on ultrasound requiring hysteroscopic investigation
- Subfertility investigation requiring direct assessment of tubal patency by laparoscopic dye test (chromopertubation)
- Abnormal uterine bleeding not responding to medical treatment with a suspected structural cause requiring hysteroscopic diagnosis and treatment
Symptoms of Laparoscopy and Hysteroscopy
- Chronic pelvic pain consistently worse around menstruation (dysmenorrhoea) suggesting endometriosis or pelvic adhesions
- Deep dyspareunia (pain on deep vaginal penetration) suggesting posterior compartment endometriosis or ovarian endometrioma
- Intermenstrual or post-coital bleeding suggesting endometrial polyp, submucosal fibroid, or cervical pathology
- Palpable adnexal mass requiring laparoscopic inspection and possible ovarian cystectomy or oophorectomy
- Infertility with a normal ovulation and sperm analysis but suspected pelvic adhesions or tubal blockage
- Recurrent pregnancy loss with a suspected intrauterine structural abnormality (septum, adhesion, fibroid) requiring hysteroscopic correction
- Acute lower abdominal pain with positive pregnancy test and empty uterus on transvaginal ultrasound suggesting ectopic pregnancy
- Heavy irregular vaginal bleeding with a submucous fibroid or endometrial polyp identified on ultrasound
Key Benefits
Discover the advantages of choosing our laparoscopy and hysteroscopy services.
Laparoscopy is the gold standard for endometriosis diagnosis and treatment in a single procedure
Hysteroscopic polyp resection resolves abnormal bleeding in 90% of patients
Laparoscopic ovarian cystectomy preserves ovarian tissue compared to open surgery
Same-day discharge for most laparoscopic and hysteroscopic procedures
Laparoscopic sterilisation provides permanent highly effective contraception with rapid recovery
Clinical Features
The technology, techniques and clinical approach behind our laparoscopy and hysteroscopy.
CO2 insufflation pressure maintained below 15 mmHg throughout laparoscopy
Systematic pelvic organ inspection documented photographically with AFS endometriosis staging
Uterine manipulator used for optimal pelvic organ positioning
Hysteroscopy performed under direct vision throughout
All port wounds closed under direct laparoscopic vision confirming haemostasis
Preparation Instructions
Fast from midnight before the procedure or as instructed. Take the prescribed antibiotic prophylaxis if given. Shower with antiseptic wash the evening before and morning of the procedure. Arrange transport home and a responsible adult to stay with you for 24 hours. A pregnancy test is performed on the day of the procedure.
The Procedure
Step-by-step guide to what you can expect during your laparoscopy and hysteroscopy procedure.
Pre-Operative Assessment and Surgical Planning
Pre-operative blood tests confirm FBC clotting and group and save. The clinical indication and surgical plan are discussed. The patient is counselled on the specific risks of the planned procedure.
Anaesthesia Induction and Peritoneal Insufflation
Under general anaesthesia a Veress needle is inserted through a small umbilical incision and the peritoneal cavity is insufflated with CO2 gas to 12 to 15 mmHg -- creating the working space for the laparoscope.
Systematic Pelvic Organ Inspection
The laparoscope provides a magnified view of the entire pelvis. A systematic inspection of the uterus tubes ovaries peritoneum and pouch of Douglas is performed. Endometriosis deposits are documented by site extent and AFS stage.
Operative Intervention
For operative laparoscopy -- endometriosis ablation or excision ovarian cystectomy salpingectomy or sterilisation -- additional 5mm ports provide access for instruments and a uterine manipulator allows optimal positioning.
Hysteroscopy and Intrauterine Assessment
The hysteroscope is passed through the cervical canal into the uterine cavity under direct vision. The uterine cavity is distended with normal saline. A systematic inspection of the endometrium and any intrauterine pathology is performed.
Operative Hysteroscopy and Closure
Polyps are resected with hysteroscopic scissors or a morcellator. Submucosal fibroids are resected with a resectoscope. Ports are removed under vision confirming haemostasis and wounds are closed with dissolvable sutures.
What to Expect
General anaesthesia is administered. The abdomen is gently inflated with carbon dioxide gas for laparoscopy. The laparoscope is inserted through the umbilicus and the pelvic organs are inspected. Any treatment is performed through additional small incisions. For hysteroscopy the telescope is passed through the cervix and the uterine cavity is inspected and treated.
Recovery
Rest at home for 24 to 48 hours after laparoscopy. Shoulder tip pain from residual carbon dioxide gas resolves over 24 to 48 hours. Return to normal activities after 5 to 7 days for diagnostic procedures and 2 to 4 weeks for operative procedures. Attend the post-operative appointment to receive biopsy results and plan further management.
Frequently Asked Questions
Common questions about laparoscopy and hysteroscopy.
Related Services
Explore other services in our Obst & Gynec department.
Antenatal Care and Pregnancy Monitoring
Normal Labour and Delivery
Caesarean Section
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