Keyhole surgery. Fertility-first.

Both of these are keyhole procedures, and both use a camera — but they look at different things. A hysteroscopy passes a thin telescope through the cervix to inspect the inside of the uterine cavity, with no cuts at all. A laparoscopy uses small abdominal incisions to view the outside of the uterus, the ovaries, the tubes and the pelvis. They are frequently done in the same sitting, because between them they cover nearly everything an ultrasound cannot.

The distinction that matters in fertility surgery is intent. General gynaecological surgery aims to remove disease. Fertility surgery aims to remove disease while protecting every bit of ovarian reserve and healthy tissue, because that reserve is the raw material of any future pregnancy. Removing an endometriotic cyst carelessly can strip away normal ovarian tissue along with it and leave a woman with fewer eggs than she started with. The technique used, the energy settings, and how tissue planes are handled all change the outcome.

The other major advantage is that diagnosis and treatment happen together. A polyp seen on hysteroscopy is removed in the same procedure. Adhesions found on laparoscopy are divided then and there. Endometriosis is staged and excised in one anaesthetic rather than being confirmed in one operation and treated in another.

These are day-case procedures. Most patients arrive in the morning, go home the same evening, and are back to routine activity within one to seven days depending on what was done. Recovery from a diagnostic hysteroscopy is usually a matter of hours; a laparoscopy for extensive endometriosis takes longer.