What is Laparoscopic Surgery?
Laparoscopic (or keyhole) surgery involves putting a thin telescope through a small incision in the abdomen to inspect the internal organs which are displayed on a large screen. If abnormalities are found, a further two incisions are made to allow for instruments to be inserted and surgery to be performed. Dr Jessup generally uses very thin instruments (5mm in diameter) so no sutures are required after the surgery and there is minimal scarring. The patient is fully anaesthetised and gas is used to distend the abdomen to allow vision and surgical procedures. Recovery time is usually fast with most patients returning home the same day as their surgery.
Dr Jessup is a very experienced surgeon, performing several laparoscopic procedures each week.
Laparoscopic Surgery for Ovarian Cysts
Ovarian cysts are common in women of all ages. It is important they are monitored for growth or recession to make sure they are not potentially cancerous. Large cysts can also rupture, twist the ovary and make IVF difficult. In these cases removal is necessary. Laparoscopic surgery is an easy way to remove cysts without the need to remove the ovary. Three small 5mm incisions are made in the abdomen with most patients returning home the same day. Dr Jessup aims to preserve fertility as much as possible in her pre-menopausal patients.
Laparoscopic Surgery for Endometriosis
Endometriosis is a common condition where tissue similar to the endometrium (which lines the inside of the uterus) grows outside the uterus. The most common places to find endometriosis are behind the uterus, between the uterus and the bladder, on the ovaries and on the bowel. These patches of endometriosis bleed during menstruation, cause considerable period pain and can cause sex to be painful. In time they can also cause adhesions, where the pelvic organs get stuck together. The only way endometriosis can be definitively diagnosed is by having a laparoscopy. During this surgery, the deposits of endometriosis can be cut out or burned and the adhesions can be divided, returning the pelvic anatomy to a normal state.
The current best practice for the management of endometriosis is with a combination of surgery and medical hormone therapy. Having repeated laparoscopies has been shown to sometimes cause a decrease in ovarian reserve (the number of eggs a woman has left). For this reason, Dr Jessup generally limits laparoscopies for endometriosis to three circumstances:
Prior to trying to conceive either naturally or with IVF
Laparoscopic Surgery for Infertility
Many patients have done Dr Jessup's basic fertility workup and found that their partner’s sperm is normal and that they are ovulating normally. What remains is to check the fallopian tube function. This can either be performed by Dr Jessup in her rooms (a HyCoSy or Lipiodol HSG procedure) or can be tested with dye studies at laparoscopy.
For women with no history of any risk factor for tubal obstruction, Dr Jessup rarely suggests surgery. However, for women with a history of past chlamydia, a ruptured appendices or a previous delivery, laparoscopies will often identify the fertility issues more accurately and allow subsequent natural conception rather than the need for IVF.
Laparoscopy for fertility involves three 5mm incisions in the abdomen and the passing of a hysteroscope into the uterus. Many patients who elect for this option, often coupled with Lipiodol Flushing, conceive within the next cycle or two.
Laparoscopic Surgery for Tubal Ligation
Tubal ligation, commonly known as “having your tubes tied” is a permanent method of birth control for women. The most common method of permanently blocking the fallopian tubes is by applying a small metal and rubber clip (filshie clip) to each fallopian tube. This procedure requires a quick general anaesthetic and involves a 5mm incision near the umbilical and a 7mm incision just about the pubic hair line. There are no sutures that need to be removed and contraception is immediate.
Many women who have finished their families choose this method as they do not want to keep taking hormones (such as the estrogen and progesterone found in most other methods of contraception). With tubal ligation, there are no long term complications, the periods continue as normal and menopause occurs at the normal time.
Although tubal ligation is considered permanent contraception, there are a couple of options for women wishing to conceive again should circumstances change. It may be possible to remove the filshie clips and rejoin the fallopian tubes, however, it is more common for a woman to use IVF to bypass the tubal blockage as this tends to be more successful.