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Chapter-02 Exposure in laparoscopic surgery

BOOK TITLE: Minimally Invasive Gynecologic Surgery: Evidence-Based Laparoscopic, Hysteroscopic and Robotic Procedures

Author
1. Fernandes Rodrigo A. Brant
2. Meza Carolina
3. Moros Jesús Castellano
4. Wattiez Arnaud
ISBN
9781909836099
DOI
10.5005/jp/books/12892_3
Edition
1/e
Publishing Year
2016
Pages
8
Author Affiliations
1. Doheny Eye Institute, Keck School of Medicine at the University of Southern California, Los Angeles, CA, Universidade Federal de, S. Paulo-UNIFESP/EPM, São Paulo, Brazil
2. Strasbourg University Hospital, IRCAD, Strasbourg, France
3. Medifem, Zulia, Venezuela; IRCAD, Strasbourg, France
4. University of Strasbourg, Strasbourg, France
Chapter keywords
endometriotic infiltration, invasive techniques, uterine manipulators, gynecological procedures, image magnification, infundibulopelvic ligament, colposacropexy procedures, laparoscopic hysterectomy, specific strategies, retroperitoneal structures, para-aortic lymphadenectomy, embryological spaces, infectious complications

Abstract

This chapter discusses exposure in laparoscopic surgery, which is obtained through a combination of steps that maintain the surgical field while freeing up the assistant. In laparoscopy, the surgeon is often obliged to work with small, delicate instruments, and specific traction and countertraction movements are adopted to facilitate precise dissection. A bowel void of fecal and gaseous content is easier to handle and place above the promontory, free of the pelvis, thereby improving surgical access and exposure. The first assessment of the pelvis should include a systematic and detailed anatomical survey. The inspection should start by ruling out upper abdominal adhesions or endometriotic implants that may explain patient symptoms. Colposacropexy procedures require dissection of the right border of the promontory, continuing medially to the right ureter towards both pararectal fossas. Laparoscopic colposacropexy is the standard technique for pelvic organ prolapse repair. Exposure is a key factor to the success of laparoscopic procedures.

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