Laparoscopy is a minimally invasive surgical technique that often plays an important role in the diagnosis and/or treatment of infertility.
In laparoscopy, a small incision is made in the umbilicus (navel or belly button) and the laparoscope (a long narrow instrument with a lens at one end) is inserted, allowing the physician to evaluate the reproductive organs (uterus, fallopian tubes, and ovaries).
Examples of fertility problems that can be corrected with laparoscopy include removal of adhesions (scar tissue) from around the fallopian tubes and ovaries, opening of blocked tubes, removal ovarian cysts, and treatment of endometriosis. In certain situations, uterine fibroids can also be removed laparoscopically.
Laparotomy is abdominal surgery involving a large incision (2-6 inches). It is similar to a C-section. Only a limited number of reproductive surgical procedures are performed nowadays by laparotomy.
Common infertility surgeries that require larger exposure of the reproductive system (hence larger incisions) include removal of fibroid tumors (myomectomy), reversal of tubal ligation, some cases of severe endometriosis and scar tissue, and ruptured ectopic (tubal) pregnancies. Most reproductive surgeries can be otherwise performed on an outpatient basis through small incisions (laparoscopy).
Most laparotomies involve a transverse (side-to-side) incision in the lower abdomen. In the event a larger exposure is needed, a vertical (up-and-down) incision is performed.
Most laparotomies are followed by a hospital stay of 1-4 days and recovery period of 2-6 weeks. The risks of laparotomy are bleeding, infection, injury, or anesthesia complications.
The decision to perform a laparotomy vs. a laparoscopy depends on the type of problem encountered and the surgeon's experience.