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MagazineOctober 2003 (Vol. 14 Issue 7)Laparoscopy

Infertility leaves many couples feeling helpless, even hopeless, and at the mercy of modern medicine in the quest to do what Mother Nature intended us to do - create life

Infertility leaves many couples feeling helpless, even hopeless, and at the mercy of modern medicine in the quest to do what Mother Nature intended us to do - create life.

Laparoscopy is a procedure orthodox medicine has come up with to help evaluate and treat infertility problems, and gynaecological problems like endometriosis, uterine fibroids, ovarian cysts and ectopic pregnancy. It allows visualisation of the uterus, fallopian tubes and ovaries via a laparoscope, an instrument using fibreoptic light to illuminate the abdomen.

The laparoscope is inserted through the vagina or abdomen with the patient under general anaesthesia. Carbon dioxide is released into the abdomen to help separate the organs, making it easier for the physician to manoeuvre around the reproductive organs. If defects or abnormalities are found, diagnostic laparoscopy becomes operative laparoscopy.

In this case, the doctor inserts additional instruments - such as probes, scissors, grasping instruments, biopsy forceps, electrosurgical or laser instruments and other suture materials - through two or three incisions, made just above the pubic bone, to deal with the problem.

If all goes well, the outcome may be positive, and most of the literature suggests there is little risk with laparoscopy. Yet, three out of every 1000 laparoscopic procedures lead to serious complications, even death. One study found that, in 1995-1997, 594 structures/organs were injured in 506 patients, with 65 deaths (J Am Coll Surg, 2001; 192: 478-91). A survey of 1958 gynaecologists revealed that 4 per cent had injured a major vessel during laparoscopy at some point in their career (J Soc Laparoendosc Surg, 1999; 3: 331-4; Am J Surg, 1995; 169: 543-5).

Other risks include perforation of the bowel, bladder, uterus and other organs during the insertion of various instruments through the abdominal wall. Certain conditions can also increase the risk of complications: previous abdominal surgery; pelvic infections; and obesity or extreme thinness.

One study analysing the risk associated with laparoscopic instruments found three types of injuries linked to a trocar (a sharp instrument used to puncture the abdominal wall and withdraw fluids). Out of 629 trocar injuries reported over three years, 408 were to major blood vessels, 182 were to organs and 30 were haematomas. Among these cases were 32 deaths, mostly due to vascular injuries (J Am Coll Surg, 2001; 192: 677-83).

Other postop complications include adverse reactions to the gas (Fem Patient, 1977; 2: 61-4), bladder and incision infections (Anaesth Intens Care, 2003; 31: 211-3; Tunis Med, 2000; 78: 634-40), urinary retention (Int Urogynecol J Pelvic Floor Dysfunct, 2003; 14: 94-7) and deep vein thrombosis (Int J Surg Invest, 2000; 2: 41-7).
Megan McAuliffe


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