# Laparoscopy and Hysteroscopy in Gynaecology

> Laparoscopy and hysteroscopy notes for NEET-PG Obstetrics and Gynaecology: CO2 pneumoperitoneum, entry technique, distension media and glycine toxicity.

- Canonical URL: https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/laparoscopy-and-hysteroscopy-gynaecology
- Exam / course: NEET-PG · Subject: Obstetrics and Gynaecology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Laparoscopy and Hysteroscopy in Gynaecology", PrepElephant, https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/laparoscopy-and-hysteroscopy-gynaecology

## Direct answer

Laparoscopy establishes a carbon dioxide pneumoperitoneum at 12-15 mm of mercury and works through 5-10 mm ports — diagnostically for endometriosis staging, infertility, chronic pelvic pain and ectopic pregnancy, operatively for hysterectomy, cystectomy, myomectomy and tubal surgery — while hysteroscopy, the gold standard for intrauterine pathology, distends the cavity with normal saline (bipolar and mechanical surgery) or glycine 1.5 per cent (monopolar resectoscopes). Complications follow physics: major vessel injury on entry (rare but lethal), bowel and bladder injury, embolism and port-site hernia in laparoscopy; perforation, bleeding and glycine toxicity — dilutional hyponatraemia with hyperammonaemic encephalopathy — in hysteroscopy, prevented by fluid-balance accounting and hard stops.

## What you must remember

- **Entry options:** Veress and trocar at the umbilicus, the open Hasson technique for the adhered abdomen, and Palmer's point (left upper quadrant) after previous midline surgery — the standard exam trio.
- **Laparoscopic complications:** major vessel injury about 0.3 per 1000 (sudden collapse with retroperitoneal swelling — laparotomy and vascular surgery), bowel and bladder injury 1-3 per 1000, carbon dioxide embolism, hypercarbia, shoulder-tip pain (C3-C5 phrenic irritation), port-site hernia.
- **Advantages and contraindications:** less pain, shorter stay, better visualisation — against haemodynamic instability, dense adhesions, advanced malignancy (relative).
- **Hysteroscopic distension media:** normal saline for bipolar and mechanical systems (danger is volume overload); glycine 1.5 per cent for monopolar resectoscopes (non-conductive, hence hyponatraemia risk); pressures below the mean arterial pressure.
- **Fluid discipline and glycine toxicity:** record input-output every 10 minutes during resectoscopy; stop at a glycine deficit of about 750-1000 mL (saline 2500 mL), check sodium, and treat toxicity — restlessness, confusion, visual disturbance, seizures — with fluid restriction, furosemide and 3 per cent saline for seizures.
- **Hysteroscopy procedures:** polypectomy, submucous myomectomy (transcervical resection), septal incision, adhesiolysis for Asherman syndrome; office vaginoscopic hysteroscopy ("no-touch") is expanding diagnostics.
- **Perforation:** the commonest operative hysteroscopy complication (fundus and cornua) — laparoscopy and observation when uncomplicated, exploration if bowel is injured.
- **Laparoscopic ovarian drilling:** four to six thermal points per ovary at 40 watts for 4 seconds in clomiphene-resistant polycystic ovary syndrome — ovulation with a lower multiple-pregnancy rate than gonadotrophins.

## Two procedures, one safety thread

The thread running through both endoscopies is that every complication is a physics invoice. In laparoscopy the dangerous seconds are the blind ones — the Veress needle and first trocar, with the aorta a few centimetres beyond a thin wall — hence the rules: Veress at 45 degrees toward the pelvis head-down, aspiration and hanging-drop verification before insufflation, or Hasson or Palmer's point after previous surgery. The sudden collapse with a rising retroperitoneal shadow is the vascular catastrophe — immediate laparotomy, aortic compression, vascular surgery. In hysteroscopic resection the invoice is written in glycine: a monopolar resectoscope irrigating a vascular bed can absorb litres of hypotonic fluid, and the woman who was chatting becomes restless, then confused, then seizes — sodium 118, glycine toxicity. Prevention is bookkeeping (input-output every 10 minutes, stop at deficit); treatment is rapid: stop resecting, check sodium, 3 per cent saline for seizures, furosemide and fluid restriction. A uterine perforation is usually the lesser event — laparoscopic survey for bleeding and bowel, overnight observation, the resection completed another day.

## India's endoscopic trajectory

Indian gynaecological endoscopy has crossed from metropolitan boutique to mainstream, unevenly: corporate and teaching hospitals run full services while a district hospital may offer only diagnostic laparoscopy — exam answer and referral reality coexist. Cost is the honest barrier: disposable trocars, morcellators and bipolar devices are out-of-pocket, pushing Indian units towards reusable instruments; insurance caps on consumables decide surgical route as often as judgement. Training is the bottleneck — FOGSI-recognised fellowships and structured minimally invasive training respond, since safe entry's learning curve is where complications cluster. Historical pride point for viva: modern operative laparoscopy was born in gynaecology — Kurt Semm, a German gynaecologist, performed the first laparoscopic appendicectomy in 1980 to a reception of disbelief. The Indian exam favourites: why carbon dioxide (highly soluble, rapidly excreted, less embolism risk), the glycine toxicity triad, and the fluid deficit stop rule.

## Frequently asked questions

### Why is carbon dioxide the standard insufflation gas?

It is highly blood-soluble and excreted by the lungs, so bubbles are absorbed rather than persisting — embolism is rarer and smaller than with air or nitrous oxide.

### How is safe entry achieved after previous abdominal surgery?

Open Hasson or Veress at Palmer's point (left upper quadrant), away from expected midline adhesions — never blind umbilical entry.

### What is glycine toxicity and how is it recognised?

Absorbed hypotonic glycine 1.5 per cent causing dilutional hyponatraemia with hyperammonaemia — restlessness, visual disturbance, seizures during or after resectoscopy; treat with 3 per cent saline, furosemide, fluid restriction.

### At what fluid deficit is hysteroscopic surgery stopped?

At about 750-1000 mL of glycine (about 2500 mL of normal saline), with immediate sodium assessment — a hard stop, not a judgement call.

### How is a routine hysteroscopic perforation managed?

Stop, assess laparoscopically for bleeding and bowel injury; uncomplicated fundal perforations are observed overnight, lateral or bowel injuries need repair.