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Endometriosis: how laparoscopics art performed ENDOMETRIOSIS: HOW LAPAROSCOPICS ART PERFORMED
Laparoscopics are most often conducted at a hospital or clinic where the patient normally it put under general anesthesia. General anesthesia is the best agent for women undergoing laparoscopics, although a number of patients may benefit from local anesthesia along with a common analgesic like Demerol or Valium, the alternate choice sometimes preferred by doctors. Surgery begins with an incision mat is made either in the navel or directly below it. A small peritoneal needle is then inserted through the navel into the abdomen, into which is pumped four liters of carbon dioxide (CO2) gas. (Carbon dioxide is preferred over oxygen because it is safer—nonexpibsive and easily absorbable. The biggest problem with oxygen is that it is flammable; sometimes doctors use lasers and electrocautery during this procedure, and any oxygen will cause burns in the abdomen.) After the gas has properly inflated the abdomen, the laparoscope is inserted into the incision.
The doctor wants to get the best and most unobstructed view of the pelvic organs. To do that, he adjusts his patient's position. The carbon dioxide has already helped separate the organs, so they can be seen more clearly. Now he will tip the patient so her head is tilted downward, causing the bowel to float upward toward the chest. This position provides him with the required unobstructed view of the pelvic organs, which are set slightly afloat in the distended abdomen.
The laparoscope provides a viewing lens and a light—much like a flashlight shining through a buttonhole. When the laparoscope is in place, the doctor looks through it, moving it within its range of flexibility to view his patient's internal organs. He may also introduce other instruments through it earner to move aside an organ that may block a view or to perform minor surgery.
If a doctor notices any abnormality—of the ovaries, for example-he is able to insert a needle through the hollow laparoscope and aspirate, or remove, sample cells from this organ for a biopsy. A tissue biopsy is the best way to diagnose endometriosis, but the process can be tricky. The endometrial implant may be on a part of an organ mat is difficult to get to, or the implant may be so small that it is difficult to get a proper sample. There are occasions, too, where taking a tissue sample for a biopsy is successful, but there may be some confusion about the mutts of the biopsy.
Since the fallopian tubes are delicate structures, the doctor will check them for adhesions, to see if they have narrowed or are obstructed, a possible result of endometriosis, or if there are any ravaging effects of previous conditions. At this point during the procedure, he can inject a blue dye, which will define the condition of the rubes and reveal whether or not they are open. One result of pelvic inflammatory disease, for example, is that the fimbriated (fingerlike) ends of the tubes clump together and lose their ability to transport the egg horn the ovary to the tube, where conception normally takes place. A number of other procedures that may involve the fallopian tubes are available, such as testing for obstructions by injecting dyes and tracing their course, otherwise known as a hysterosalpingogram, which will be discussed in full very shortly.
When the laparoscopy is over, the carbon dioxide gas is let out, the abdomen deflates, and the small incision is either sewn or stapled closed and covered with a Band-Aid—hence the procedures sobriquet. There may be a few aftereffects from the surgery, such as slight nausea, difficulty urinating, and sometimes pain in the shoulders, but these episodes are brief Shoulder pain, should it occur, is a result of the tilted position during the operation and the pressure of the CO2 gas against the diaphragm. This pressure irritates nerves and pain radiates up to the shoulders. Most women, however, are able to return home the following day without any problem. For about a week or two, abdominal soreness or a dull pain may be bothersome, but in general, the only sign of surgery should be a tiny unseen scar in the navel, and sex is safely resumed about a week after surgery.
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