Diagnostic Hystero-Laparoscopy

Medically reviewed by Dr Manan Boob, MBBS (KEM), MS ObGyn (Gold Medalist), DNB — Consultant Gynaecologist & Laparoscopic Surgeon

What it is

Diagnostic hystero-laparoscopy is a single short operation that combines two telescope examinations. In hysteroscopy, a thin telescope passes through the cervix to look at the inside of the womb. In laparoscopy, a telescope passed through a small cut near the navel looks at the outside of the womb, the tubes, the ovaries and the lining of the pelvis. Done together, under one anaesthetic, they let us see the whole reproductive tract with our own eyes, and often treat small problems in the same sitting.

It is part of the work of our advanced laparoscopy and hysteroscopy department. If you would like to read about the womb-only procedure in detail, see our page on diagnostic and operative hysteroscopy, and you can see all the procedures we perform.

Who needs it

The commonest reason is a couple who have been trying for a baby for a year or more, whose basic tests look normal, and in whom we still want to know why. Our guide on when to see a fertility specialist explains the signs that make us look further.

We advise it when:

• fertility tests are normal or unclear and the cause of not conceiving is still unexplained;
• a dye test or scan suggests a blocked or damaged tube;
• there is a suspected polyp, septum, fibroid or scar tissue inside the womb;
• you have long-standing pelvic pain, painful periods or painful intercourse and endometriosis or adhesions are suspected;
• you have had repeated miscarriages or failed fertility treatment and want the womb and pelvis checked before the next attempt;
• you have had infection, surgery or a ruptured appendix in the past and adhesions are possible.

“Do I really need an operation just to find out what is wrong?” I understand the hesitation. If the simpler tests have already given a clear answer, you may not. But when they have not, this is the one test that actually looks at the structures. Many couples spend a year or more on treatment that is not aimed at the real cause, and one carefully done look can save that time.

How it is done

You are asked to fast, and the anaesthetist puts you to sleep. The operation is planned for the days just after your period ends, when the womb lining is thin and the view is best.

We usually begin with the laparoscopy. A small cut is made near the navel, gas is gently passed into the abdomen, and the telescope goes in. One or two slim ports are placed low in the abdomen. We look at the womb, both tubes, both ovaries, the pouch behind the womb and the lining of the pelvis, checking for endometriosis, adhesions, cysts and any other abnormality.

Next comes the hysteroscopy. A thin telescope is passed through the cervix, the womb is gently filled with fluid, and we look at the cavity, the lining and the openings of the tubes for polyps, a septum, scar bands or fibroids.

If your tubes need to be tested, a blue dye is passed through the cervix while we watch through the laparoscope. If the dye flows freely out of the ends of both tubes, they are open; if it does not, we know exactly where the problem lies. This is often the most useful part of the whole procedure.

If we find a small problem and you have already consented, we deal with it then: removing a polyp, dividing a septum or scar band, treating small endometriosis deposits, releasing adhesions or draining a small cyst. Anything larger is explained to you and planned separately. A tissue sample can be taken from the womb lining if needed.

The gas is released, the small cuts are closed, and you wake up in recovery.

Anaesthesia, duration and hospital stay

The procedure is done under general anaesthesia.

A purely diagnostic look takes about 30 to 45 minutes. If we treat something as well, it can take an hour or a little more.

Most women go home the same day or the next morning. Someone should take you home, and you should not drive yourself.

Recovery

Day 1. Mild cramping like a period, sore small cuts, a bloated tummy and shoulder-tip pain from the gas, which is normal and fades. You will be eating and walking within hours. Light spotting is expected.

The first week. Tiredness and mild soreness settle over three to five days. Spotting may continue for several days. You can shower from day two or three, keeping the dressings dry. Simple painkillers are usually enough.

Weeks 2 to 4. Back to normal activity. Avoid heavy lifting and strenuous exercise for the first couple of weeks. If we treated something inside the womb, we may ask you to avoid intercourse or tampons for a short period.

By six weeks. Fully recovered. We go through the findings and photographs with you at the follow-up visit and plan the next step, whether that is trying naturally, treatment or IVF. Please call us earlier if you have fever, heavy bleeding, severe or worsening pain, vomiting, or redness spreading around a cut.

Why keyhole rather than open surgery

The point of this procedure is to see everything without a big cut. Through two or three tiny openings and the cervix, we get a magnified view of the womb and pelvis that no scan can match, and the recovery is days rather than weeks. Open surgery would never be done just to look. It would only be considered if a keyhole procedure could not be completed safely, which is uncommon.

Risks and complications

Hystero-laparoscopy is a very commonly done and safe operation, but I list the risks plainly so that you know them.

• Shoulder-tip pain and bloating from the gas, common and temporary.
• Bleeding from the cuts or the womb lining, usually minor.
• Infection at a cut or in the womb or pelvis, which is uncommon and treated with antibiotics.
• Injury to the bowel, bladder, blood vessels or womb during insertion of the instruments, rare, and if it happens it is usually recognised and repaired at once. It may need a longer stay or, very rarely, open surgery.
• Fluid overload from the fluid used in the womb, rare with careful monitoring.
• Not finding a clear answer. A normal result is itself useful, but some couples still have no obvious cause afterwards.
• Anaesthetic risks, which the anaesthetist will discuss with you separately.

Alternatives

Ultrasound and a dye test of the tubes (HSG). These are simpler and are often done first. They are less informative about endometriosis, adhesions and the inside of the womb, and a dye test can sometimes suggest a block that is not really there.

Office hysteroscopy. A look inside the womb alone, without anaesthesia, for women who only need the womb examined.

Moving straight to IUI or IVF. In some couples, especially when age or sperm results make time important, it is reasonable to go straight to treatment without a diagnostic operation. We will tell you honestly if we think that is the better route in your case.

Waiting and trying naturally. Reasonable for a younger couple who have been trying for under a year with no known problem.

What it costs

The figure below is all-inclusive — surgeon’s fee, operation theatre, anaesthesia, room rent for a typical stay, medicines and routine investigations.

Diagnostic hystero-laparoscopy: ₹40,000 – ₹55,000.

Please note: The figures above are indicative estimates for a typical case. The final cost depends on your individual condition, the complexity of the surgery, the room category you choose, how long you stay, and any complications that arise. Deluxe and super-deluxe rooms are charged higher. Emergency admissions and night or holiday surgery attract additional charges. These charges are subject to change without prior intimation. Please call us on +91-8668954915 for a written estimate for your own case before you decide anything.

Preparing for your surgery

• Bring all earlier reports: scans, semen analysis, hormone tests, any dye test and your earlier treatment records.
• Tell us about allergies, diabetes, thyroid problems, blood thinners and any previous operations.
• Plan the date with us for just after your period ends.
• Do not eat or drink for the number of hours the anaesthetist advises, usually six to eight.
• Do not use vaginal creams or medicines in the days before unless we have asked you to.
• Arrange for someone to accompany you home, and keep a day or two free to rest.
• Ask your husband or partner to come to the consultation as well. Fertility is a shared journey and the answers help both of you.

---

If you have been trying for a baby without success, or live with unexplained pelvic pain, a clear look inside is often the most useful next step. The gynaecology and laparoscopy team at Shubham Hi-Tech Hospital, Amravati, will go through your reports, tell you honestly whether this procedure will help, and plan with you from there. Call +91-8668954915 or get in touch here.

Disclaimer: This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor for guidance specific to your situation.