A laparoscopy forms the cornerstone for the surgical evaluation of the pelvis of an infertile woman after a basic infertility investigation is completed. In some cases where endometriosis, pelvic inflammatory disease, or pelvic pain needs evaluation, it may be indicated earlier in the evaluation. The laparoscopic procedure is sometimes combined with a hysteroscopy when indicated.
Laparoscopy is performed under general anesthesia in a surgical center. A small needle is inserted into the abdominal cavity and C02 gas is introduced. The laparoscope (a telescope with a strong light and camera) is introduced through the navel. A variety of instruments can be inserted into the pelvis, through other small incisions, to perform diagnostic and corrective surgery.
This procedure allows Dr. Kustin to visualize the internal organs where reproduction occurs. In every case, he undertakes a meticulous surgical evaluation of the pelvis documenting his findings by video (it is routine for Dr. Kustin to review this video with his postoperative patients so that they may gain a first hand understanding of their surgical problems).
As part of the surgical evaluation the following are examined:
- Evaluation of the tubes and ovaries.
- Exclusion of endometriosis, both overt and subtle
- Identification of adhesions
- Inspection of the uterus and the exclusion of fibroids
- Inspection of the appendix, intestine, gall bladder, liver, and upper abdominal cavity
Operative Laparoscopy (Laser Laparoscopy)
Many pelvic disorders can be treated safely and even the most distorted pelvis can be reconstructed using operative laparoscopy, always performed at the time of the diagnostic procedure. In the new millennium, laparotomy is rarely indicated because of the associated pain, scaring, and patient discomfort.
Dr. Kustin has had advanced training (and is certified in the use of several lasers) as well as over twenty years of experience in performing minimally invasive gynecological surgery. He is able to perform even the most complex operations using the laparoscope, thus avoiding painful laparotomy (a large incision to enter the pelvis compared to three or four small incisions required at laparoscopy.) He was one of the first physicians in the Pacific Northwest to perform these complex laparoscopic surgeries and continues to offer state of the art surgical techniques, as they are proven and become available.
The advantages of the laparoscopic approach are as follows:
Laparoscopy involves small incisions with far less postoperative discomfort and a rapid recovery time
- Less adhesion formation
- Markedly reduced hospital stay. Many procedures are easily performed as an outpatient and are cost effective.
Procedures that Dr. Kustin routinely performs via operative laparoscopy include:
Surgical Technique- A Synopsis
- Removal of scar tissue around the tubes and ovaries (salpingolysis and/or ovariolysis) and opening blocked tubes (tuboplasty).
- Removal of ovarian cysts and endometriomas with reconstruction of the ovary to a fully functional state.
- Removal of endometriosis including advanced stage three and four disease involving both bowel and the urinary system. This is often done employing a multidisciplinary approach with a bowel surgeon and a urologist in attendance.
- Removal of uterine fibroids (even those involving the uterine cavity) with uterine reconstruction to a fully functional state.
- Removal of ectopic pregnancies with conservation of the fallopian tube where indicated.
- Tubal reanastamosis after tubal ligation (sterilization)
- Complete hysterectomy performed laparoscopically.
Operative laparoscopy is a delicate undertaking requiring not only advanced training but also great skill and dedication. Both mental and physical discipline and excellent hand eye coordination are prerequisites to successfully performing minimally invasive pelvic surgery. Small instruments are used to grasp and expose the operative site. A variety of lasers (CO2, Argon, YAG, and KTP) may be used as part of the surgery.
Once the diseased tissue is removed, sutures may be placed, via the laparoscope, in order to reconstruct the pelvic organs. These techniques reduce trauma and facilitate timely healing with reduced postoperative adhesion formation. There are very few complications when an experienced specialist performs the procedure and the overall results are very gratifying for both patient and physician.