The etymological meaning of the word “endoscopy” is “to 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 contraceptive method, 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 interior of the uterus and perform interventions (Hysteroscopy).
Laparoscopy
It is performed in the operating room, under general anesthesia and with a preparation of the patient similar to any major intervention. The advantage of laparoscopy over open surgery is that everything is done through small incisions or punctures.
A gas is introduced through a special needle introduced through the navel, to make a balloon of the abdominal wall and thus avoid injury to neighboring organs. A light and optical system is then introduced through the same incision, which 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 instruments necessary for each intervention can be manipulated. With the instruments and technical means currently available, there are two broad indications for laparoscopy:
- Exploratory.
- Surgical.
Indications for exploratory laparoscopy:
- Fertility studies.
- Abdominal pain.
- Abdominal adhesive syndrome.
- Endometriosis, especially of micro-implants that are not visible by other diagnostic means.
- Malformations of the genital tract.
- Inflammations or abdominal infections.
Indications of Surgical Laparoscopy
- Tubal ligation.
- Fulguration of endometriotic implants.
- Ectopic pregnancies – Ovarian cysts.
- Removal of fibroids.
- Release of adhesions.
- Hysterectomy assisted by laparoscopy.
Contraindications for laparoscopy:
- Previous abdominal surgeries.
- Severe endometriosis.
- Morbid obesity.
- Previous peritonitis.
In all of them there is a risk of abdominal organ injury accidents, which should be avoided and another type of surgery should be used.
Hysteroscopy
As already explained, this is an endoscopic technique for exploring or performing operations inside the cavity of the uterus. It can be performed either in the office or in the operating room, depending on the indication required.
In Consultation: It is used as an exploratory diagnostic tool and even for the extraction of IUDs or small biopsies. It is performed with a system of flexible light and optics that allows it to be performed without anesthesia or with a slight analgesia. The patient finishes her consultation and returns to her normal life.
In the operating room: It requires anesthesia and / or sedation, as it is used to perform surgery in the uterine cavity. The hysteroscope is no longer flexible and the auxiliary instruments are more complex. Anyway, it is an outpatient surgery that requires the patient to be in the clinic for only a few hours normally.
Indications
- Uterine synechiae (adhesions).
- Malfomations (endouterine septa).
- Tubal obstruction (Essure Method).
- Endometrial polyps.
- Intracavitary myomas.
- Extraction of complicated IUDs.
- Endometrial ablation (burning the inner layer of the uterus when there are hemorrhages or functional alterations of menstrual bleeding).