Endoscopic surgery is a type of surgical procedure performed through very small incisions in the abdomen or other body cavities, using specialized instruments. Laparoscopy refers to surgery in the abdomen and pelvis, while hysteroscopy refers to surgery in the uterine cavity. Minimal scarring surgery is another term to describe these types of procedures.

What is Laparoscopy?
In laparoscopy, a thin instrument (only a few millimeters in diameter!) is used to give the surgeon an exceptionally clear view of the abdominal and pelvic cavity on a TV monitor. The abdominal cavity is entered through an incision in the navel. The abdomen is then inflated with CO2 gas to allow space to operate and manipulate organs and tissues. Usually, other tiny incisions are needed to insert various instruments to assist the surgeon with operating. Various pathologies like endometriosis and peritubal adhesions (scarring) that are often not visible by ultrasound imaging can be diagnosed and treated by laparoscopy.

What is Hysteroscopy?
With hysteroscopy, a much thinner telescope (hysteroscope) is used to visualize the uterine cavity. A Normal Saline solution (similar to water) is used to distend the uterine cavity for visualization. The benefit of hysteroscopy is that subtle lesions missed frequently on ultrasound and/or X ray can be clearly diagnosed and readily treated with a hysteroscope.

What is Transvaginal Endoscopy (TVE)?
Transvaginal Endoscopy (TVE), a combination of hysteroscopy and transvaginal hydrolaparoscopy, is a revolutionary technique used for direct visualization and assessment of the entire female reproductive system. The procedure is done under light sedation with only one needle puncture to enter the abdomen through the vagina and behind the uterus. A Normal Saline solution, instead of CO2 gas, is used to visualize the entire female pelvis directly. Post-operative recovery is fairly quick, with most patients feeling back to normal within hours.

It is important to note that subtle uterine and pelvic pathology can only be diagnosed under direct visualization. This novel procedure allows for the accurate diagnosis of infertility causes when other basic tests fail to reach a diagnosis, leading to the frequently inaccurate diagnosis of “unexplained infertility” (basically, a diagnosis that is reached when physicians run out of answers to explain the real cause of infertility). Remember, having a real diagnosis is the most important step in managing fertility patients.