Diagnostic Laparoscopy

What is it and how is it done

It is a special examination performed in a hospital under general anesthesia. Using a special organ, the laparoscope, we can examine the inside of the abdomen and the inner genital organs of the woman from a small 1 cm opening on the umbilicus.

The laparoscope is a “telescop” of a 10-11 mm diameter. There are two types of laparoscopes, diagnostic and invasive. Invasive laparoscopes have an internal lumen of a 5-7 mm diameter, from which tools or the beam of laser CO2 can pass. To establish a connection with laser CO2, a special coupler is needed that makes the laser beam to pass through the centre of the lumen without being reflected in the walls (which would result in the loss or the laser power). Diagnostic laparoscopes have a better and brighter image because they use the entire diameter of the laparoscope for brightness and imaging, while in the invasive laparoscopes the lumen of the tools limits the available surface for the transfer of light and image. Laparoscopes can visualize directly (under a 0ο angle, which is the most usually used) or under an 8ο, 30ο or 45ο angle.

The laparoscope is connected via a optical fibre cable, with a could light source (Xenon). The camera, which is of very small weight, allows the projection of the image on a coloured screen and the recording of the procedure. In order to achieve a good imaging, the abdomen is distended, i.e. the abdomen is filled in with gas. The gas used is carbon dioxide (CO2) which is supplied through a special electronic device called the insuflator. The insuflator is pre-configured with regard to the intra-abdominal pressure and it automatically regulates the CO2 supply in a pre-selected range. The intra-abdominal pressure should not exceed the internationally accepted safety limits. The use Of CO2 does not have any side-effects. After the completion of the procedure, the abdomen is emptied of CO2. The traces left of the gas are absorbed and the organs reclaim their normal positions.

What is laparoscopy useful for

Laparoscopy offers valuable help in the diagnosis of several gynecological conditions related to infertility. Many of them are not possible to diagnose otherwise (such as using ultrasound or hysterosalpingography).

Using laparoscopy we can examine:

  • The size and morphology of the uterus, fallopian tubes and ovaries (Image 1).
  • The permeability of the fallopian tubes which is ensured by introducing a special dye (methylene blue) through the cervix and expecting it to come out from the other end of the tube (infundibulum and fimbria) (Image 2)
  • The ovarian-fallopian tube relation, i.e. optimal contact of infundibulum and fimbria of each tube with the respective ovary. (Image 3)
  • The pathology of inner genital organs, particularly endometriosis and adhesions.

Laparoscopic Images

Image 1 - The size and the morphology of the uterus, the fallopian tubes and the ovaries.Image 2 - The patency of the fallopian tubes, which can be checked with the insertion of a special dye (methylene blue) under small pressure through the uterine cervix. For the tubes to be patent, the dye has to come out of their ends (the infundibulum and the fimbria).Image 3 - The fallopian tubes-ovaries relation, i.e. the right contact of the infundibulum and the fimbria of each tube with the corresponding ovary.

See also:
Endometriosis
Adhesions
Hydrosalpinges
Congenital anomalies of the uterus
Fibroids
Ovarian cysts
Ectopic pregnancy