The etymological meaning of the word "endoscopy" is "see inside". It is, therefore, a technique that allows us to explore inside organs, cavities, etc., which otherwise would not be possible, since it would be necessary to use more aggressive surgical methods.
In Gynecology, since Palmer introduced it in 1962 to operate the fallopian tubes as an irreversible method of contraception, it is used to:
- Observe the abdominal cavity where the female internal genital apparatus and the rest of the abdomen are located, being able to operate if necessary ( Laparoscopy ).
- Explore the inside of the uterus and perform interventions ( Hysteroscopy ).
It is performed in the operating room, with general anesthesia and with a preparation of the patient similar to any major intervention. The advantage that Laparoscopy brings over open surgery is that everything is done through small incisions or punctures.
A gas is introduced through a special needle introduced by the navel, to make a balloon of the abdominal wall and thus avoid injury to neighboring organs. Through this same incision a light and optical system is introduced that allows us to visualize the abdominal cavity and to be able to operate in it.
This is combined with one or two auxiliary and lateral punctures through which the necessary instruments can be manipulated in each intervention.. With the instruments and technical means available today, two broad indications for Laparoscopy can be made:
Indications for exploratory laparoscopy :
- Studies for Fertility.
- Abdominal pains
- Abdominal adherent syndrome.
- Endometriosis, especially of microimplants that are not visible by other diagnostic means.
- Malformations of the genital system.
- Inflammations or abdominal infections.
Indications for Surgical Laparoscopy
- Tubal ligation.
- Fulguration of endometriosis implants.
- Ectopic pregnancies - Ovarian cysts.
- Removal of myomas.
- Adhesion release.
- Hysterectomy aided by Laparoscopy.
Contraindications of laparoscopy :
- Previous abdominal surgeries.
- Severe endometriosis
- Morbid obesity.
- Previous peritonitis.
In all of them there is a risk of injury to abdominal organs, which should be avoided and use another type of surgery.
As already explained, it is an endoscopic technique to explore or perform operations inside the uterine cavity. It can be done both in consultation and in the operating room, everything depends on the indication that is required.
In Consultation : It is used as an exploratory diagnostic means and even for IUD extraction, so small biopsies. It is performed with a flexible light and optic system that allows it to be carried out without anesthesia or with a mild analgesia. The patient finishes her consultation and returns to her normal life.
In Operating Room : Requires anesthesia and / or sedation, since it is used to perform surgical interventions in the uterine cavity. The hysteroscope is no longer flexible and the auxiliary instruments are more complex. In any case, it is an outpatient surgery that forces the patient to be in the clinic for a few hours only normally.
- Uterine synechia (adhesions).
- Malfomations (endouterine partitions).
- Tubal obstruction (Essure method).
- Endometrial polyps.
- Intracavitary myomas.
- Removal of IUDs, complicated s.
- Endometrial ablation (burning of the inner lining of the uterus when there are hemorrhages or functional alterations of menstrual bleeding).