The first gynecologic procedures involving a laparoscope included exploratory laparoscopy to diagnose ovarian disease such as cysts, torsion, and cancer. Since then, more complex operations have developed, including laparoscopic removal of a tubal pregnancy, harvest of eggs for in vitro fertilization, and -- more recently --laparoscopic removal of the uterus (hysterectomy) or the ovaries. For complex laparoscopic operations, patients should consult with a primary health care provider to find a medical facility that specializes in the specific operation. The procedure is usually done in the hospital, under general anesthesia. A catheter is inserted through the urethra into the bladder. An additional tube, called a nasogastric (NG) tube, may be passed through the nostril and into the stomach to remove intestinal contents. The skin of the abdomen is cleansed, and sterile drapes are applied. A small incision is made above or below the navel to allow the insertion of a tube called a trocar, which allows passage of a tiny video camera into the abdomen. Prior to insertion of the trocar, a needle is inserted into the incision and carbon dioxide gas is injected to elevate the abdominal wall, thereby creating a larger space to work in. This allows for easier viewing and manipulation of the organs. The laparoscope is then inserted so that the organs of the pelvis and abdomen can be examined. Additional small incisions are made for instruments that allow the surgeon to move organs, cut tissue, suture, and staple structures as needed to safely and effectively perform the procedure. Following the examination, the laparoscope is then removed, the incisions are closed with sutures, and bandages are applied. Depending upon the operation performed, a drain may be left through one of the incisions to allow for drainage of accumulated fluid.
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