This video demonstrates the Diagnostic Laparoscopy Tubal Patency Test by ICG and Ovarian Drilling. Often, women with polycystic ovary syndrome (PCOS) do not have regular menstrual periods. This usually means that a woman doesn’t ovulate every month and may have trouble getting pregnant. Hormone treatments like birth control pills can help make periods more regular but will prevent a woman from getting pregnant. There are fertility medicines that may help women with PCOS to ovulate more regularly and increase their chance of becoming pregnant.

These include clomiphene citrate, aromatase inhibitors, and metformin. When these medicines do not work, some women may be helped with a surgical procedure called ovarian drilling. This procedure is sometimes called “whiffle ball” surgery, modified wedge resection, and other names. What is ovarian drilling and how does it work? Women with PCOS usually have ovaries with a thick outer layer. The ovaries make more testosterone. High testosterone levels can lead to irregular menstrual periods, acne, and extra body hair. Ovarian drilling works by breaking through the thick outer surface and lowering the amount of testosterone made by the ovaries. This can help the ovaries release an egg each month and start regular monthly menstrual cycles. This may make it easier to get pregnant. How is ovarian drilling done? A minimally invasive surgery called laparoscopy is used for ovarian drilling. A thin, lighted telescope (laparoscope) is put through a small surgical cut (incision) near the belly button. A tiny camera is used to see the ovaries. The surgeon inserts tools through other tiny incisions in the lower belly and makes very small holes in the ovaries. This helps lower the amount of testosterone made by the ovaries. What are the benefits of ovarian drilling? The goal of this procedure is to restore a woman’s menstrual cycle and help her ovulate. About 50% of women get pregnant in the first year after surgery. Some women still may not have regular cycles after the surgery. Others may have other fertility problems (such as blocked tubes or a low sperm count) that can prevent pregnancy. Ovarian drilling is a one-time treatment, unlike fertility medicines that have to be taken every month.

Having twins or triplets is not as likely with ovarian drilling as with fertility medicines. However, the benefits of ovarian drilling are not permanent. Ovulation and menstrual cycles may become irregular again over time. For some women with PCOS, ovarian drilling will not fix the problems with irregular periods and ovulation, even temporarily. However, ovarian drilling can help a woman respond better to fertility medicines. What are the risks of ovarian drilling? The decision to do ovarian drilling should not be made lightly. While problems from ovarian drilling are rare, some can be serious. Some of the risks are related to surgery. As with all surgical procedures, there are risks of bleeding, anesthesia, and infection. Also, laparoscopy can cause injury to the bowel, bladder, and blood vessels. Very rarely, there is a risk of death. There are also risks to fertility. If there is too much damage to the ovary during the ovarian drilling procedure, a woman may enter menopause at a younger age than expected. After the procedure, adhesions (scarring) can form between the ovaries and the fallopian tubes, making it hard to get pregnant.

Infertility is a growing concern worldwide, and modern gynecology offers minimally invasive solutions to diagnose and treat reproductive issues effectively. Diagnostic laparoscopy is one such approach that provides both diagnostic and therapeutic benefits. Two important procedures often performed during laparoscopy are the tubal patency test using Indocyanine Green (ICG) and ovarian drilling.

Tubal Patency Test by ICG
What is Tubal Patency Testing?

Tubal patency testing evaluates whether the fallopian tubes are open and functional, a crucial factor in natural conception. Blocked or damaged tubes can prevent fertilization, making this test essential for infertility workup.

Why Use Indocyanine Green (ICG)?

ICG is a fluorescent dye that has gained popularity due to its safety, precision, and real-time visualization. Unlike traditional dyes like methylene blue, ICG provides enhanced imaging under near-infrared light, allowing the surgeon to assess tubal patency with higher accuracy.

Procedure Overview

Preparation: The patient is placed under general anesthesia.

ICG Injection: ICG dye is introduced into the uterine cavity.

Laparoscopic Visualization: Using a laparoscope equipped with near-infrared imaging, the surgeon observes the flow of ICG through the fallopian tubes.

Assessment: Open tubes allow smooth passage of the dye into the peritoneal cavity, confirming patency. Any blockages or adhesions are identified immediately.

Benefits:

Minimally invasive and highly precise

Immediate results for tubal assessment

Can detect subtle peritubal adhesions

Safe with minimal side effects

Ovarian Drilling
What is Ovarian Drilling?

Ovarian drilling is a laparoscopic surgical procedure primarily used to treat women with polycystic ovary syndrome (PCOS) who have ovulation problems. This procedure aims to restore normal ovulation and improve fertility.

How Ovarian Drilling Works

The surgeon uses laparoscopic energy devices (like diathermy or laser) to make tiny punctures in the ovarian surface. These punctures reduce excess androgen production and improve hormonal balance, which helps stimulate regular ovulation.

Procedure Overview

Anesthesia: The patient is placed under general anesthesia.

Laparoscopy: A laparoscope is inserted through a small abdominal incision.

Drilling: Multiple small holes are made in the ovaries using precise energy application.

Recovery: Patients typically recover quickly and may resume normal activities within a few days.

Benefits:

Restores ovulation in PCOS patients resistant to medications

Minimally invasive with faster recovery compared to open surgery

Can be combined with tubal patency testing during the same laparoscopy

Advantages of Combining Procedures

Performing both ICG-based tubal patency testing and ovarian drilling in a single laparoscopic session provides:

Comprehensive infertility evaluation

Reduced anesthesia exposure

Immediate treatment for PCOS-related ovulatory issues

Early identification of tubal or pelvic adhesions

Conclusion

Diagnostic laparoscopy with ICG tubal patency testing and ovarian drilling is a highly effective approach in infertility management. These procedures not only help identify underlying causes of infertility but also provide therapeutic solutions in a minimally invasive manner. With advanced laparoscopy, patients benefit from faster recovery, reduced complications, and improved chances of conception.

Contact Us: World Laparoscopy Hospital Cyber City, Gurugram, NCR Delhi INDIA Phone/WhatsApp: +919811416838