Pelvic Laparoscopy

Information, Resources & Education

What is Pelvic Laparoscopy?

Pelvic laparoscopy is a surgical procedure that examines and treats a woman's pelvic organs through a small surgical viewing instrument (laparoscope) inserted into the abdomen at the navel.

How is Pelvic Laparoscopy performed?

After the female patient has been administered anesthesia and is deep asleep and pain-free under general anesthesia, a one-half-inch incision is made in the skin below the navel (umbilicus). Carbon dioxide is pumped into the abdomen to make the organs of the abdominal cavity more easily visible.

The laparoscope, an instrument similar to a small telescope on a flexible tube, is inserted so the area can be viewed. Other instruments may be inserted through other incisions in the lower abdomen to obtain tissue samples or perform additional procedures. After the pelvic laparoscopy is completed, the carbon dioxide gas is released, and the incisions are stitched.

Pelvic laparoscopy is used both for diagnosis and for treatment and may be recommended for the following conditions or symptoms:
 
*  Pelvic pain
*  Uterine tissue found outside the uterus in the abdomen (endometriosis) 
*  Infections (pelvic inflammatory disease) not responsive to drug therapy 
*  Suspected twisting (torsion) of an ovary 
*  Ovarian cyst 
*  Scar tissue (adhesions) in pelvis 
*  Perforation (puncture) of the uterus following D and C or by an IUD 
*  Infertility evaluation 
*  Sterilization (tubal ligation) 
*  Evaluation and removal of an abnormal pelvic mass that was confirmed by abdominal
    ultrasound 
*  Removal of uterine fibroids (myomectomy) 
*  Removal of uterus (hysterectomy) 
*  Surgical treatment of tubal pregnancy 
*  Evaluation of a woman who may have appendicitis or salpingitis 

Pelvic laparoscopy is not recommended for patients with:

*  Severe obesity 
*  Existing severe pelvic adhesions from previous surgeries 

Laparoscopic procedures are growing more popular with physicians, especially with the advent of more high-tech laparoscopes.

Pelvic Floor Dysfunction
Information, Resources & Education

What is Pelvic Floor Dysfunction?

Pelvic floor dysfunction, which is also referred to as outlet obstruction or outlet delay, refers to a condition in which the pelvic floor muscles of a woman's lower pelvis - that surround the rectum, do not function normally. It is not known why these muscles fail to work properly in some women, but they can make the passage of stools difficult even when everything else seemingly is normal.

What Causes Pelvic Floor Dysfunction?

Women with pelvic floor dysfunction find that muscle pain occurs when muscles are tense, strained, traumatized and/or otherwise inflamed. Their pelvic muscles are no exception. Causes of pelvic floor dysfunction can include:

*  Chronic faulty posture with weak core musculature 
*  Trauma (fall on tailbone, old tailbone fracture, auto accident)
*  Inflammation or infection
*  Pelvic organ disease (endometriosis, irritable bowel syndrome, interstitial cystitis) 
*  Repetitive motion injuries such as those from gymnastics, volleyball, soccer, ballet or ice
    skating
*  Abdominal muscle wall weakness or hernias 
*  Chronic constipation
*  Pregnancy or complicated vaginal delivery 
*  Abdominal or pelvic surgery such as a hysterectomy 

Do I have Pelvic Floor Dysfunction?

Women with pelvic floor dysfunction often have changes in their spine and/or pelvis.  Symptoms or conditional might include; scoliosis, short leg, swayback or a "torsioned" sacrum. The most common symptoms of pelvic floor dysfunction include one or more of the following:

*  Vaginal pain 
*  Pain with urination 
*  Urinary urgency and frequency 
*  Rectal pain 
*  Pain during vaginal intercourse 
*  Pain with sitting, standing, walking 
*  Pain and/or difficulty getting up from a seated or lying down position
*  Hip pain often with loss of range of motion in hips 
*  Deep pain in lower back radiating to legs, thighs, groin, hips 
*  Abdominal and lower abdominal/intestinal pain
*  Pelvic pressure or a feeling like your vagina or uterus are "falling out."
*  Involuntary loss of urine or stool

What are Pelvic Adhesions?

Pelvic adhesions are the cause of many gynecological problems including significant pain, infertility and conception. Pelvic adhesions are irritations of a woman's pelvic organs as a result of a "pelvic inflammatory event" or from trauma to the area such as in the case of pelvic or gynecological surgery.

Examples of a pelvic inflammatory event include; fallopian tube infections that might occur from endometriosis, removal of an ovarian cyst, sexually transmitted diseases such as gonorrhea, post surgery infections, and even appendicitis and appendectomies. 

As a woman's body's pelvic area recovers from an inflammation, trauma or surgery, it begins the healing process and starts to repair itself.  The woman's body and its' healing process may cause some tissues and structures in the pelvis to become unintentionally "stuck" to another tissue or structure. In a normal woman's healthy pelvis, this space is lined with a tissue called the peritoneum, which also covers the outside of organs located in the abdomen and pelvis. In the pelvis of a non-injured/non-irritated woman, the peritoneum can be very "slippery" with the the organs and structures lying immediately next to each other that "slip" off each other and do not become bonded together. With a woman who has had a pelvic inflammation, trauma or injury, her body's healing process starts a sequence of events that may result in some of the pelvic tissues becoming "stuck" to or "adhering" to tissues or organs next to the inflamed, or injured tissue, and when this occurs, the outcome may be pelvic adhesions.

What is Pelvic Organ Prolapse?

Pelvic Organ Prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown. 

Pelvic Organ Prolapse may also be called; genital prolapse, pelvic relaxation, pelvic prolapse, uterine prolapse, uterovaginal prolapse, pelvic floor disorder, urogenital prolapse or vaginal wall prolapse.

What is a Pelvic Prolapse?

Pelvic Prolapse is another term used for "pelvic organ prolapse."  Pelvic prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown. 

Pelvic Prolapse may also be called; genital prolapse, pelvic relaxation, uterine prolapse, uterovaginal prolapse, pelvic floor disorder, urogenital prolapse or vaginal wall prolapse.

What is a Prolapsed Uterus?

A Prolapsed Uterus refers to a collapsed uterus, or descended uterus, or other change in the position of the uterus in relation to the surrounding structures within the pelvis. The pelvis contains many soft tissue structures vital to normal body functions, supported primarily by the diaphragms, layers of muscles, fibrous coverings called fasciae, and various ligaments and tendons. These soft tissues of the pelvis derive their ultimate support from the bony pelvis. 

A Prolapsed Uterus may be one of three types, depending on the severity:

• First-degree prolapse occurs when the uterus sags downward into the upper
vagina.

• Second-degree prolapse occurs when the cervix is at or near the outside of the
vagina.

• Third-degree prolapse (sometimes referred to as total prolapse) occurs when the entire uterus extends outside the vagina.

What is a Vaginal Vault Prolapse?

The vaginal vault is the area at the top of the vagina, next to and adjacent to the cervix. It can only “fall” or descend downwards toward the introitus, or the entrance of the vagina, after a woman's womb has been removed (hysterectomy). Vaginal Vault Prolapse occurs in about 15% of women who have had a hysterectomy for uterine prolapse, and in about 1% of women who have had a hysterectomy for other reasons.