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HSG & Laproscopy

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HSG & Laproscopy

A Hysterosalpingogram (HSG) is an X-ray test. It looks at the inside of the uterus camera.gif and fallopian tubes and the area around them. It often is done for women who are having a hard time getting pregnant (infertile).


Hysterosalpingogram (HSG)

During the test, a dye (contrast material) is put through a thin tube. That tube is put through the vagina and into the uterus. Because the uterus and the fallopian tubes are hooked together, the dye will flow into the fallopian tubes. Pictures are taken using a steady beam of X-ray (fluoroscopy) as the dye passes through the uterus and fallopian tubes. The pictures can show problems such as an injury or abnormal structure of the uterus or fallopian tubes. They can also show a blockage that would prevent an egg moving through a fallopian tube to the uterus. A blockage also could prevent sperm from moving into a fallopian tube and joining (fertilizing) an egg. The test also may find problems on the inside of the uterus that prevent a fertilized egg from attaching (implanting) to the uterine wall.

Laproscopy

Laparoscopic surgery, also called minimally invasive surgery (MIS), bandaid surgery, or keyhole surgery, is a modern surgical technique in which operations are performed far from their location through small incisions (usually 0.5–1.5 cm) elsewhere in the body.

There are a number of advantages to the patient with laparoscopic surgery versus the more common, open procedure. Pain and hemorrhaging are reduced due to smaller incisions and recovery times are shorter. The key element in laparoscopic surgery is the use of a laparoscope, a long fiber optic cable system which allows viewing of the affected area by snaking the cable from a more distant, but more easily accessible location.

There are two types of laparoscope: (1) a telescopic rod lens system, that is usually connected to a video camera (single chip or three chip), or (2) a digital laparoscope where the charge-coupled device is placed at the end of the laparoscope.

Also attached is a fiber optic cable system connected to a "cold" light source (halogen or xenon), to illuminate the operative field, which is inserted through a 5 mm or 10 mm cannula or trocar. The abdomen is usually insufflated with carbon dioxide gas. This elevates the abdominal wall above the internal organs to create a working and viewing space. CO2 is used because it is common to the human body and can be absorbed by tissue and removed by the respiratory system. It is also non-flammable, which is important because electrosurgical devices are commonly used in laparoscopic procedures.

Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. Specific surgical instruments used in a laparoscopic surgery include: forceps, scissors, probes, dissectors, hooks, retractors and more.Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy.

Advantages

There are a number of advantages to the patient with laparoscopic surgery versus an open procedure. These include:

  • Reduced hemorrhaging, which reduces the chance of needing a blood transfusion.
  • Smaller incision, which reduces pain and shortens recovery time, as well as resulting in less post-operative scarring.
  • Less pain, leading to less pain medication needed.
  • Although procedure times are usually slightly longer, hospital stay is less, and often with a same day discharge which leads to a faster return to everyday living.
  • Reduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections.
  • There are more indications for laparoscopic surgery in gastrointestinal emergencies as the field develops.
  • Although laparoscopy in adult age group is widely accepted, its advantages in pediatric age group is questioned. Benefits of laparoscopy appears to recede with younger age. Efficacy of laparoscopy is inferior to open surgery in certain conditions such as pyloromyotomy for Infantile hypertrophic pyloric stenosis. Although laparoscopic appendectomy has lesser wound problems than open surgery, the former is associated with more intra-abdominal abscesses.

    Disadvantages

    While laparoscopic surgery is clearly advantageous in terms of patient outcomes, the procedure is more difficult from the surgeon's perspective when compared to traditional, open surgery :

  • The surgeon has limited range of motion at the surgical site resulting in a loss of dexterity.
  • Poor depth perception.
  • Surgeons must use tools to interact with tissue rather than manipulate it directly with their hands. This results in an inability to accurately judge how much force is being applied to tissue as well as a risk of damaging tissue by applying more force than necessary. This limitation also reduces tactile sensation, making it more difficult for the surgeon to feel tissue (sometimes an important diagnostic tool, such as when palpating for tumors) and making delicate operations such as tying sutures more difficult.
  • The tool endpoints move in the opposite direction to the surgeon's hands due to the pivot point, making laparoscopic surgery a non-intuitive motor skill that is difficult to learn. This is called the Fulcrum effect
  • Some surgeries (carpal tunnel for instance) generally turn out better for the patient when the area can be opened up, allowing the surgeon to see "the whole picture" surrounding physiology, to better address the issue at hand. In this regard, keyhole surgery can be a disadvantage.
  • Risks

    Some of the risks are briefly described below :

  • The most significant risks are from trocar injuries during insertion into the abdominal cavity, as the trocar is typically inserted blindly. Injuries include abdominal wall hematoma, umbilical hernias, umbilical wound infection, and penetration of blood vessels or small or large bowel.
  • The risk of such injuries is increased in patients who have a low body mass index or have a history of prior abdominal surgery. While these injuries are rare, significant complications can occur, and they are primarily related to the umbilical insertion site. Vascular injuries can result in hemorrhage that may be life-threatening. Injuries to the bowel can cause a delayed peritonitis. It is very important that these injuries be recognized as early as possible.

  • Some patients have sustained electrical burns unseen by surgeons who are working with electrodes that leak current into surrounding tissue. The resulting injuries can result in perforated organs and can also lead to peritonitis. This risk is eliminated by utilizing active electrode monitoring.
  • There may be an increased risk of hypothermia and peritoneal trauma due to increased exposure to cold, dry gases during insufflation. The use of Surgical Humidification therapy, which is the use of heated and humidified CO2 for insufflation, has been shown to reduce this risk.
  • Many patients with existing pulmonary disorders may not tolerate pneumoperitoneum (gas in the abdominal cavity), resulting in a need for conversion to open surgery after the initial attempt at laparoscopic approach.
  • Not all of the CO2 introduced into the abdominal cavity is removed through the incisions during surgery. Gas tends to rise, and when a pocket of CO2 rises in the abdomen, it pushes against the diaphragm (the muscle that separates the abdominal from the thoracic cavities and facilitates breathing), and can exert pressure on the phrenic nerve. This produces a sensation of pain that may extend to the patient's shoulders. For an appendectomy, the right shoulder can be particularly painful. In some cases this can also cause considerable pain when breathing. In all cases, however, the pain is transient, as the body tissues will absorb the CO2 and eliminate it through respiration.
  • Coagulation disorders and dense adhesions (scar tissue) from previous abdominal surgery may pose added risk for laparoscopic surgery and are considered relative contra-indications for this approach.
  • Intra-abdominal adhesion formation is a risk associated with both laparoscopic and open surgery and remains a significant, unresolved problem.Adhesions are fibrous deposits that connect tissue to organ post surgery. Generally, they occur in 50-100% of all abdominal surgeries, with the risk of developing adhesions being the same for both procedures. Complications of adhesions include chronic pelvic pain, bowel obstruction, and female infertility. In particular, small bowel obstruction poses the most significant problem.The use of surgical humidification therapy during laparoscopic surgery may minimise the incidence of adhesion formation.Other techniques to reduce adhesion formation include the use of physical barriers such as films or gels, or broad-coverage fluid agents to separate tissues during healing following surgery.