Laparoscopy
This method is used to look inside body cavities and see what is causing problems. In gynaecological laparoscopy, the surgeon inserts a hollow tube (which is equipped with lights and lenses) into the abdomen through a small incision (about 1 cm) near the navel. Some gas, usually carbon dioxide, is put into the abdominal cavity through the laparoscope to distend the abdomen. This makes the intestines fall back from the abdominal wall so that the reproductive organs and pelvic cavity can be seen clearly.
Biopsy of tissues and some procedures such as dividing adhesions and tubal sterilisation may be performed during laparoscopy. If anything is done in addition to inspecting the pelvis, a second tube through which instruments can be passed is inserted through a small incision near the pubic hairline.
Laparoscopy is done in an operating theatre with general anaesthetic. If the examination is done early in the day you can usually go home in the evening; sometimes you may need to stay a night or two in hospital. There are usually few after-effects: just some drowsiness from the anaesthetic and perhaps a bloated, uncomfortable feeling in the abdomen for a day or two.
Laparotomy
This is an exploratory surgical procedure; the abdomen is opened so that organs can be directly inspected for signs of disorder or disease. Laparotomy is performed less often now that we have diagnostic aids such as ultrasound and CAT scans. Gynaecological laparotomy has to some extent been replaced by laparoscopy, but if a problem needing surgical removal is suspected (such as ectopic pregnancy or complications with an ovarian cyst), laparotomy is usually done.
Hysteroscopy
A tube similar to a laparoscope is inserted through the cervix into the uterine cavity so that the surface of the endometnum can be inspected. Hysteroscopy is usually part of the investigation into the cause of abnormal uterine bleeding.
Techniques have now been developed that enable most or all of the endometrium to be removed or destroyed through the hysteroscope, using diathermy or laser. This is called endometrial ablation, a procedure that may in the future replace hysterectomy as a way of treating bleeding problems that can’t be otherwise corrected.
Hystеrоsalpingogram
This X-ray examination of the interior of the uterus and fallopian tubes detects any abnormalities in their cavities. A narrow catheter is inserted through the vagina into the cervical canal. Radio-opaque dye is injected through the catheter into the uterus and an X-ray is taken to capture the outline of its cavity. If the tubes are not blocked, the dye passes freely through them and spills out into the peritoneal cavity. More pictures are taken as the dye flows through the tubes so that the location and extent of any blockage can be studied. The procedure takes 10-20 minutes and may cause some uterine cramps, and occasionally pain is felt at the shoulder tip.
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