Surgical procedures explained

Laparoscopy

A laparoscopy may be suggested to investigate pelvic pain, period problems or infertility.

A laparoscopy is a key-hole surgery where a gynaecologist can look at the organs in the abdomen and pelvis. The laparoscope (camera) is inserted through a small 1 cm incision in the umbilicus (the belly button), and an additional incision is made in the lower pelvic region to insert extra surgical instruments. This procedure allows inspection of the outside of the uterus, the ovaries and the surrounding organs. Assessment of fallopian tube patency is also performed at the same time (to see whether the fallopian tubes are blocked).

During the procedure it may be possible to remove ovarian cysts, endometriosis, fibroids and blocked fallopian tubes. Additional incisions may be required to perform these procedures.

A laparoscopy is performed in a hospital under general anaesthetic. A typical laparoscopy may take 30 minutes and often a hysteroscopy (see below) is performed at the same time. Most patients will be discharged within a few hours after the procedure. However, approximately 1 in 40 patients may be required to stay overnight.

After a laparoscopy, patients will require time off work and routine activities. Most women will be able to return to work after five days, however this is variable – some women may only require two days of recovery, whereas some may require seven days of recovery.

Hysteroscopy, Dilation of cervix & Curettage (D&C)

A hysteroscopy is a procedure performed on women to view the cavity of the uterus and take a sample of its lining (endometrium).

During the procedure, the cervix is dilated to allow the passage of a hysteroscope (camera) through the vagina and into the uterus. Typically, no incisions are required. When the hysteroscope is inserted, it may be possible to see polyps, fibroids or scar tissue. These can be removed at the same time. A sample of the endometrium (curettage) is taken and sent to the pathology laboratory to look for causes of infertility or abnormal bleeding, such as infection or cancer.

A hysteroscopy is a relatively minor procedure performed in a day surgery unit under general anaesthetic. The procedure typically takes less than 30 minutes.

After a hysteroscopy, patients will not be able to go to work on that day. However, many will be able to return to work the next day, or the day after that.

Non-surgical fallopian tubal patency assessment (ultrasound or x-ray)

In some cases, infertility may be due to blockage of a woman’s fallopian tubes. Blockage may result from endometriosis, previous pelvic infection, ectopic pregnancy or surgery.

While assessment of the fallopian tubes can occur through a laparoscopy, assessment can also be performed without surgery, via an ultrasound or an x-ray (hysterosalpingogram [HSG]). During the procedure, a speculum is inserted into the vagina (similar to a pap test) and a fine catheter (tube) is passed into the cervix. A fluid is injected into the uterus and visualised as it passes through the fallopian tubes, showing if any blockages are present.

The procedure is usually performed in the first half of the menstrual cycle, after menstrual bleeding has ceased and before ovulation occurs – that is, between days 5–10 of the cycle.

The procedure takes up to 30 minutes. It generally has minimal side effects, although some discomfort and cramping can occur. However, most patients report it to be no more painful than period pain. Any pain experienced usually resolves shortly after the procedure is finished. Pain may also be relieved by taking pain relief medication (e.g. naproxen, mefenamic acid) 30 minutes before the procedure.

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