Female infertility is a common disease in obstetrics and gynecology, which brings great mental and social pressure to patients. With the continuous development of hysteroscopic and laparoscopic equipment and technology, combined hysteroscopic and laparoscopic examination and surgery can enable many infertility patients to be effectively treated.
Since its introduction in the 19th century, hysteroscopy has undergone more than 100 years of development and improvement, and the technical equipment has become increasingly mature. Hysteroscopy is an advanced device for diagnosis and treatment of diseases in the uterine cavity, which can clearly observe various changes in the uterine cavity and make a clear diagnosis. Hysteroscopy is a high-tech, minimally invasive gynecological treatment technology that can be used for diagnosis, treatment and follow-up of intrauterine cavity lesions.
Hysteroscopy
A very thin mirror is placed into the uterine cavity for observation through the body’s natural orifice, the cervix, to determine not only the location, size, appearance and extent of the lesion present, but also to make a detailed observation of the tissue structure on the surface of the lesion and to take or position the hysteroscope for scraping under direct vision. Hysteroscopy is a minimally invasive gynecologic technique that integrates modern gynecologic surgery and endoscopic techniques. Its safety and effectiveness have been recognized, and it is gradually becoming the preferred option for the treatment of various intrauterine disorders.
Advantages of hysteroscopic surgery
Since the operation is performed using the natural channels of the human body, it has the advantages of no abdomen opening, no incision, little trauma, less bleeding, less pain and faster recovery.
Hysteroscopic surgery is divided into three main categories
1.Simplicity: endometrial polyp removal, intrauterine foreign body removal, tubal cannulation, etc.
2.Restorative: through operations such as cutting, cautery, peeling and decomposition, the abnormal, deformed and diseased uterine cavity can be restored to its normal anatomical state and physiological function. Such as intrauterine adhesion decomposition, septotomy and submucosal myomectomy, etc.
3. Destructive: endometrial removal. Laparoscopy was first used in clinical practice in 1910, and after decades of continuous improvement, 80-90% of open surgery was converted to laparoscopic surgery after the 1990s.
Laparoscopic techniques are of great importance in the diagnosis of infertility. The standard LS examination is considered to be the gold standard for female reproductive tract examination. LS examination has been included in the routine screening of infertile women in developed countries.
The uterus, fallopian tubes and related organs in the pelvis can be explored for abnormalities, and the patency of the fallopian tubes can be assessed by injecting melanoma fluid under the catheter in the uterine cavity after a full examination. The laparoscopy can be performed at different stages of the menstrual cycle according to the indications.
If in vitro fertilization or intrafallopian delivery of gametes is desired, laparoscopy should be performed when the follicles reach maturity according to endocrine measurements and ultrasound monitoring.
Advantages of laparoscopic surgery
1. surgery is performed in a closed abdominal cavity, which avoids drying of the peritoneum and thus recurrence or re-formation of adhesions
2, easier than open surgery to reach specific pelvic adhesions, especially in the two cases and the lower part of the pelvis, as well as in the lower part of the ovaries.
3. the positive pressure formed by the pneumoperitoneum has a ‘pressure hemostatic’ effect, thus greatly reducing bleeding
4, reduced the incidence of postoperative infection
5. greatly shortens the operation and recovery time.
The treatment of infertility has unique advantages: less injury, less interference, faster recovery, less postoperative pelvic adhesions, and increased chances of conception.
The role of laparoscopy in the treatment of infertility:pelvic adhesion decomposition, tubal correction, ovarian cyst surgery, pelvic endometriosis surgery.
Efficacy of laparoscopic surgery in infertility:The pregnancy rate after laparoscopic surgery in infertile patients can be as high as 50-66%, while the pregnancy rate after open surgery is about 54% combined hysteroscopic and laparoscopic examination and surgery. Hysteroscopic or laparoscopic treatment alone may cause some patients to be missed, with the consequence of inadequate treatment. For example, laparoscopic treatment of polycystic ovaries alone, followed by the discovery of uterine lesions subject to surgical treatment, often misses the best time to conceive after surgery. Laparoscopic separation of pelvic adhesions with simultaneous hysteroscopic tubal cannulation and lavage allows direct observation of the therapeutic effect. Having laparoscopic surveillance during hysteroscopic treatment of uterine abnormalities such as longitudinal septum increases the safety of the operation.
Combined hysteroscopic and laparoscopic surgical exploration is necessary and effective for infertility patients in whom more than 2 lesions cannot be excluded before surgery.