Diagnostic Laparoscopy, Hysteroscopy and Dye Test for Infertility

Aaradhya Sharma

https://www.laparoscopyhospital.com/SERV01.HTM  A complete examination of a woman's internal pelvic structures can provide important information regarding infertility and common gynecologic disorders. Frequently, problems that cannot be discovered by an external physical examination can be discovered by laparoscopy and hysteroscopy, two procedures that provide a direct look at the pelvic organs. These procedures may be recommended as part of your infertility care, depending on your particular situation. Laparoscopy and hysteroscopy can be used for both diagnostic (looking only) and operative (looking and treating) purposes. Diagnostic laparoscopy may be recommended to look at the outside of the uterus, fallopian tubes, ovaries, and internal pelvic area. Diagnostic hysteroscopy is used to look inside the uterine cavity. If an abnormal condition is detected during the diagnostic procedure, operative laparoscopy or operative hysteroscopy can often be performed to correct it at the same time, avoiding the need for a second surgery. Both diagnostic and operative procedures should be performed by physicians with surgical expertise in these areas. The following information will help patients know what to expect before undergoing any of these procedures. This surgery was performed at World Laparoscopy Hospital.  For more detail log on to http://www.laparoscopyhospital.com  For more information please contact:  World Laparoscopy Hospital  Cyber City, DLF Phase II, Gurgaon  NCR Delhi, 122002, India   Phone & WhatsApp: +919811416838, + 91 9999677788 contact@laparoscopyhospital.com

Transcript

00:00hello friends this is a case of diagnostic laparoscopy with hysteroscopy for infertility

00:08this is a person 36 year old and she has primary infertility although all the hormonal and every

00:18all the medical things are fine so we will do diagnostic laparoscopy tubal potency test and

00:24hysteroscopy to see what is the cause of infertility so let us go inside the operation theater first we

00:31will see how to do access you should take two elise forceps which should be applied on either

00:39side of the crease of the umbilicus one small stab wound will be given over the inferior crease of

00:46umbilicus with 11 number of knife then the 14 or 12 centimeter various needle will be taken

00:57and that various needle you should put it over the incision side and lift the abdominal wall

01:03it should be lifted not near the various needle it is near the pubic symphysis and perpendicular to the

01:11abdominal wall you will introduce the various needle so that various needle should go towards the

01:16illness after that this is irrigation test fluid is going freely in then suction test nothing is

01:30coming out and then you will do hanging drop test that is it will be sucked in that hanging drop because

01:37of negative pressure inside the abdominal cavity after that we will attach the tubing of the insufflator

01:45pressure and pneumo plutonium will be started initial preset pressure is 15 slowly we can see actual

01:56pressure is increasing and pneumo plutonium is created you will wait till the actual pressure reach to the

02:05preset pressure right now actual pressure is 9 and flow rate after 1 liter you can increase to 3 also

02:13initially up to 1 liter of pneumo plutonium flow rate should be 1 liter per minute but once the 1 liter of

02:20gas has gone in then flow rate can be increased to 3 liter per minute and now actual pressure is 13

02:28the pressure pressure is already 15 and slowly actual pressure is reaching to the 15 and now the insufflation is

02:36over after that you should take the various needle out and enlarge the incision to 11 mm

02:47this initial 12 millimeter the 2 millimeter incision will be enlarged to 11 mm and this is now trocar will be

02:58introduced keeping it perpendicular to the abdominal wall and slowly it is entered in then we will introduce

03:08the various needle

03:12this is a telescope attach the tubing of the insufflator and then telescope will be introduced

03:20then we will use the second report patient head is going 30 degree down

03:24and head is down 30 degree that is a steep tendon bone position so that all the bobble will move up

03:32and now the secondary port is in the mcbarnie left mcbarnie point that is in between the anterior superior

03:38elic spine and umbilicus so that inferior epigastic vessel will not come in your way and you can easily

03:46introduce it and that's all for diagnostic only you need these two port some people they use suprapubic

03:54here it is according baseball if you will make a shape of a diamond with your hand then thumb is over

04:01them like us index finger over the target and this is the snuff box where you will put the port

04:08now atraumatic grasper will be introduced and diagnostic laparoscopy will start here we can see

04:14it is very nicely looking normal looking uterus and all the bobble will be lifted up lifting the

04:23bobble will show you sacral pulmonary this is the sacral pulmonary is visible here is ureter

04:29this is internal iliac this is sigmoid colon and all the structures are fine peristalsis of ureter can

04:37be appreciated and below the ureter this is internal iliac

04:40and some fluid is in the cul-de-sac which we will collect later

04:45for the histopathology and for the culture and sensitivity so these structures are visualized

04:53after that this is the peristalsis of ureter you will see within few seconds here here it is going to

05:00start and this is the peristalsis of the ureter this is internal iliac

05:06now all the structures are fine tube fimbria is visible this is triangle of doom where iliac vessels

05:13are there this is triangle of doom where the apex is deepening medially round ligament laterally

05:20samsung's artery then this is triangle of pain here you have the gfn and lfcn two nerves are visible

05:28this is gfn and lfcn through the peritoneal transparent peritoneum you can appreciate the nerves here is the

05:36cecum and ilium and there is a retrocecal buried sub serous appendix but it's okay this is the type

05:45of appendix our main concern is here the infertility

05:55so we can see this is the appendix which is visible and it is sub serous and you can find it

06:02out this is cecum this is ascending colon this is gallbladder here is the lever which is visible nicely

06:11so you have to do diagnostic laparoscopy as a clockwise fashion and you should go this is

06:18the right hypochondrium this is falsiform ligament and then you cross and this is the left lobe of the

06:26liver and here is the stomach this is the splenic flexor of colon transverse colon stomach and all

06:34these are normal pulsation of the diaphragm that is transmitted pulsation this is sigma ad colon

06:42fallopian tube ovary iliac vessel and utero sacral ligament and these all structures are visible

06:50so all these structures will be identified in a clockwise fashion and now this is ip

06:55ligament of left side you can lift it up and then you can see the ureter of the left side

07:02that will be nicely visible you can see the peristalsis and you can wait for this peristalsis

07:08this is sigmoid left ureter uterus cul-de-sac here the uterine hump this is little fluid in the cul-de-sac

07:16and this is utero cycle ligament here is the sigmoid and this is the this is the small intestine

07:25and here is the rectum now this fluid in the cul-de-sac if it is present and this is left

07:31tube this is ovary this is right tube this is bulky ovary there is a polycystic appearance of this patient

07:40so we are planning that we will do the ovary and drilling as well although there is a in ultrasound it

07:49was showing so this is ovary and drilling you can just go and you can drill it out

07:57these are the follicles

07:58and it can be punctured four to eight drill is required

08:17fimbria should be taken care of that fimbria should not touch the

08:22this this pc od needle because pc od needle can injure the tube so it is blunt and it is syringe like

08:33that pc od needle tip is blunt and when you will press a button then only needle comes out

08:40so generally four poles should be punctured 40 watt current should be used

08:44four seconds you should keep it and it's a four month for any effect to be visible

08:57so this is punctured now going to the left side again the four pole will be punctured on the left side

09:06so pc od needle has a good thing that it doesn't damage the surrounding structure because by default by a

09:17spring mechanism the needle is always inside the this tube and this is insulated tube once you will press

09:26it then only needle comes out and get activated so it is very safe and this is over

09:33so both the side the puncture of the ovarian cyst was done and now this is little fluid collected from

09:44the cul-de-sac for pcr examination or culture or sensitivity or any other purpose which you are

09:53thinking about that is fnse or any other examination now this is hysteroscopy

09:59as we can see this is entering into the cavity and now you will turn the telescope and you will turn

10:07it to see the ostia here we can see this is the left ostia your right is percent left in hysteroscopy

10:17so this is very good patent left ostia and it is nicely visible and the fluid escape is also visible

10:26after that 30 degree telescope you will turn and this is right ostia so both the ostias are fine that means

10:34there is no any space occupying lesion inside the cavity anterior wall posterior wall everything is okay

10:44good patent ostia looks like normal and you will visualize it and not only that at the same time

10:53you should try to capture the image in the second camera so you can give to the patient also

11:00so you will look for patient obviously should be post menstrual period for the diagnostic laparoscopy and

11:09hysteroscopy so that you will not have a problem of these this proliferative endoth endo material layers

11:21otherwise these proliferative phase endo material flakes will be disturbing you and it will be difficult

11:28to visualize so this ostia is nicely visible then again telescope is withdrawn out and then you will check

11:35the fundus and again you can check the posterior wall this is posterior wall this is again left ostia

11:46few frimsy additions are there near the ostial opening but that is okay you should not try to traumatize it

11:54otherwise adhesion may be more our purpose is you just to examine the endo material cavity and here it

12:02is everything is fine this is the fundus this is the posterior wall there is no any myoma or polyp in the

12:10posterior wall of uterus so you will carefully inspect every centimeter of the uterine cavity

12:17and after that similarly you can go to the fundus and then similarly you can examine the anterior wall

12:25so diagnostic hysteroscopy is always necessary when you are doing the diagnostic laparoscopy for infertility

12:34because if you were you will do both together then you can rule out almost all the uterine and tubal

12:42causes of infertility so now this is the fundus this is anterior wall anterior wall also look nice there is

12:49no any pathology over the anterior wall and here will be the internal loss region and absolutely fine

12:57normal anatomy is there then slowly you can try to withdraw the hysteroscope into the cervix again

13:05and seeing the cervical canal you will come out so this is final inspection in the panoramic view

13:22where right and left both the ostias are together visible at the level of internal loss and now it is

13:28coming out so this is the hysteroscopy is complete after that again we will go for laparoscopic

13:35view and we can see a lot of fluid inside what is this fluid oh this is good news this is the fluid which

13:42was hysteroscopic fluid has leaked from the fimbria and you should suck it immediately and then you

13:49should irrigate and suck again because these hysteroscopic fluid can bring some infection so

13:56better is to clean couple of time the pelvis and after that you will do the tubal potency test

14:03methylene blue test dye test so that is important to rule out the any of the tubal block s so hsg cannula

14:13will be connected to the this cervix and the methylene blue dye will be injected and you will inspect

14:21carefully that this dye should must come out through the fimbria this is anterior cul-de-sac posterior

14:27cul-de-sac everywhere washed out and now we are waiting for this is the movement of uterus which

14:34you can see is due to fixing the hsg cannula and here this is the this is the fimbria and we can see

14:41dye is coming and it is good this is the blue colored methylene blue showing patent tube and after

14:49that again you will inspect the another tube fimbria suction irrigation is a good instrument avoid holding by

14:56the graspers because it can create a structure so now again we will inspect and here again methylene

15:04blue should and it's coming very good so methylene blue is showing that both the tubes are patent

15:10and some methylene blue which has gone into the pelvis you should suck it out you should not leave it in

15:18and little irrigation and again cleaning of that pelvic cavity will be carried out so this way you can

15:26complete the diagnostic laparoscopy and hysteroscopy with the dye test and here in this patient our

15:33finding is that everything was normal except little pcod there was no any pathology and everything was

15:42normal in the this patient so we will do this diagnosis and after that you will come out so thank

15:50you very much for watching this video have a nice day god bless you

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