Definition of Laparoscopy :

Laparoscopy : Laparoscopy is a transperitoneal endoscopic technique that provides excellent visualization of the pelvic structures & often permits the diagnosis & management of gynaecological disorders without laparotomy.

Indications of laparoscopy :

Diagnostic indications :

1) Infertility.

2) Pelvic pain :

• Endometriosis.
• PID.
• Ectopic pregnancy.
• Unexplained pain.
• Adnexal torsion.
• Appendicitis.
• Pelvic adhesion.

3) Assessment of pelvic mass :

• Ovarian cysts.
• Fibroids.
• Pelvic adhesions.

4) Fertility problems :

• Prior to – in-vitro-fertilization.
• Prior to reversal of sterilization.
• Congenital genital tract abnormalities.
• Polycystic ovarian syndrome.
• Tubal appearance & patency.

5) Location of lost IUCD.

6) Second-look procedures.

• After malignancy therapy.
• After infertility surgery.

7) Amenorrhoea.

8) Uterine perforation.

9) Diagnosis of suspected Mullerian abnormalities.

10) Intersexuality.

Operative indications :

1. Tubal occlusion for sterilization.
2. Peritubal adhesiolysis / salpingostomy.
3. Salpingectomy /salpingostomy for ectopic pregnancy.
4. Ovarian cystectomy/oophorectomy.
5. Laparoscopic uterosacral nerve excision / ablation.
6. Ablation or excision of endometriosis.
7. Myomectomy / myolysis for fibroids.
8. Hysterectomy.
9. Infertility procedures
10. Pelvic & aortic lymphadenectomy.

Advantages of laparoscopy :

1. Rapid postoperative recovery.
2. Less postoperative pain & reduced need of postoperative analgesia.
3. Excellent visualization of organs & tissues.
4. Shorter hospital stay & reduced concomitant cost.
5. Quicker resumption of day to-day activity.
6. Less adhesion formation.
7. Minimal abdominal scar. 
8. Reduced blood loss
9. No large incisions
10. Less risk of incisional hernia.
11. Increased patient’s satisfaction.
12. Less morbidity than laparotomy.
13. Excellent visualization with magnified image using videocam & camera.

Disadvantages of laparoscopy :

1. Counter intuitive movements.
2. Indirect palpation of tissue.
3. Limited number of ports for access of abdominal organs.
4. Restricted movement of tools.
5. Need of three-dimensional vision.

Contraindications of laparoscopy :

Absolute : 

1. Severe cardiopulmonary disease.
2. Patient haemodynamically unstable.
3. Significant haemoperitoneum.
4. Intestinal obstruction.
5. Tubular peritonitis.
6. Anticoagulant therapy.

Relative : 

1. Extensive peritoneal adhesion.
2. Large pelvic tumour.
3. Large hiatal hernia.
4. Advanced malignancy.
5. Generalized peritonitis.
6. Inflammatory bowel disease.
7. Pregnancy.

Benefits of laparoscopic ovarian drilling :

1. Ovarian drilling has lower rates of ovarian hyperstimulation syndrome and of multi-fetal.
2. The advantages of the procedure also include its singular treatment, as opposed to ovulation inductions.
3. Cost-effective.
4. It can be performed as an outpatient procedure.
5. Rapid postoperative recovery.
6. Less postoperative pain.
7. Reduced need of postoperative analgesia.

Complications of laparoscopy :

Complications due to laparoscopy itself :

1. Surgical emphysema.
2. Omental emphysema.
3. Cardiac arrhythmia.
4. Injury to blood vessels.
5. Injury to bowel, bladder & ureter.
6. Gas embolism
7. Electrosurgical complications:

• Electrode burns
• Insulations defects.

Anaesthetic complications :

1. Hypoventilation
2. Hypercarbia & metabolic acidosis.
3. Basal lung atelectasis
4. Others :

• Oesophageal intubations.
• Aspiration
• Cardiac arrest.

Common complications :

1. Haemorrhage
2. Infection
3. Wound dehiscence.
4. Port site hernia.

Advantages of laparoscopic hysterectomy prior to vaginal hysterectomy :

• Diagnosis of any other pathology.
• Adhesiolysis or excision of endometriosis.
• Adnexae is freed laparoscopically
• Dissection of bladder from uterus.
• Desiccation & transaction of uterine artery.
• Entire uterus may be freed from its attachment.