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State of the Art Atlas of Endoscopic Surgery in Infertility and Gynecology
Nutan Jain
1: GENERAL
1:
OR Set-up and Basic Instrumentation for Gynecological Endoscopy
INTRODUCTION
CONCLUSION
ACKNOWLEDGMENT
2:
Laparoscopic Retroperitoneal Anatomy
INTRODUCTION
SUPERFICIAL INTRA-PERITONEAL ANATOMY (LANDMARKS TO RETROPERITONEAL STRUCTURES— Figs 2.1a to c)
PELVIC BRIM (Figs 2.2a to d)
PELVIC SIDEWALL (Figs 2.3a to g)
First Layer of Pelvic Sidewall
Second Layer of Pelvic Sidewall
Third Layer of Pelvic Sidewall
Pelvic Lymph Nodes
BASE OF THE BROAD LIGAMENT (Figs 2.4a and b)
AVASCULAR SPACES OF THE PELVIS (Figs 2.5a and b)
Prevesical (Retropubic) Space of Retzius (Figs 2.6a and b)
Paravesical Space (Figs 2.7a and b)
Pararectal Space (Figs 2.7c and d)
Vesicovaginal and Rectovaginal Spaces (Figs 2.8a to c, Figs 2.9a and b)
Presacral (Retrorectal) Space (Figs 2.10a to e)
THE PARA-AORTIC REGION (Figs 2.11a to e)
THE URETER (Figs 2.11a, 2.2d, 2.4b)
3:
Laparoscopic Access
INTRODUCTION
ACCESS INSTRUMENTS
Port Dynamics During Laparoscopy
Laparoscopic Access Techniques
First Generation Insufflated Access Methods
First Generation Non-Insufflated Access Methods
Second Generation Visual Access Method
Closed Laparoscopic Access with EndoTIP
Open Laparoscopic Access with EndoTIP
Ancillary Access with EndoTIP
Alternate Access Sites
Importance of Port Removal
CONCLUSION
4:
Laparoscopic Cutting and Hemostasis
TRAINING AND MAINTENANCE OF SKILLS
ENERGY FUNDAMENTALS
Electrosurgery
Basic Principles of Electricity
Electrosurgical Generator Output
RF Electrosurgery
Effect of RF Current on Cells and Tissues
Cutting and Vaporization
Desiccation and Coagulation
Fulguration
Controlling Tissue Effects of Electrosurgery
Generator Output
Power Density
Electrode-Tissue Proximity
Tissue Impedance or Resistance
Time on or Near Tissue
Distension Media
Other Important Variables
Electrosurgical Complications
Active Electrode Trauma
Current Diversion
Dispersive Electrode Burns
Ultrasonic Energy Systems
Lasers
Laser Physics
Laser Tissue Effects
Types of Surgical Laser
Laparoscopic Applications of Lasers
Safety Considerations
LAPAROSCOPIC SUTURING
MEDICAL AND TOPICAL HEMOSTASIS
PERFORMING CUTTING AND HEMOSTASIS
Mechanical Cutting
Mechanical Hemostasis
Clips
Hybrid Mechanical Cutting and Stapling Devices
Electrosurgical Cutting
Electrosurgical Hemostasis
Medium Caliber Vessel Hemostasis
Small Vessel Hemostasis
Hybrid Linear Cutting Electrosurgical Coagulation Devices
Ultrasonic Cutting
Ultrasonic Hemostasis
CONCLUSIONS
5:
Laparoscopic Suturing
HISTORY
TRAINING AND PRACTICE
GENERAL CONSIDERATIONS
INSTRUMENTATION AND SUPPLIES
Needles and Ligatures
Types of Ligatures
Ligature and Needle Selection
Knot Manipulators
Type I —Open Ended
Type II —Closed End
Type III —Notched
Type IV —Channelled
Needle Drivers
Handles
End Effector
Shaft
Needle Driver Alternatives
Ligature Carriers
Mechanical Suturing Devices
Introducer Sleeves
Clips and Clip Applicators
KNOTS
Overhand Knots
Half Hitch
Square Knot
Granny Knot
Surgeon's Knot
Slip Knots
LAPAROSCOPIC SUTURING TECHNIQUE
Preparation and Tissue Orientation
Insertion of Needles into the Peritoneal Cavity
Suture, Needle and Needle Driver Selection
Needle Manipulation
Ligature Carriers
Laparoscopic Knotting
Half Hitches and Variations
Intracorporeal Tying with Automated Devices
Noose Knots
Finishing Knots
Clip Ties
Extracorporeal Ties
Half Hitches and Surgeons Knots
Tying, Transferring and Securing the Knot
Sequential Knots
Slip Knots
ABDOMINAL WALL SUTURING
6:
Laparoscopic Tissue Retrieval
USE OF ENDOBAGS
ELECTROMECHANIC MORCELLATION
ENDOSCOPIC KNIFE FOR SUBTOTAL HYSTERECTOMY AND MORCELLATION
7:
Laparoscopic Adhesion Prevention
8:
Correlation of Endosonography and Endoscopic Surgery
HYSTEROSCOPY AND SONOGRAPHY
Submucous Myomas
Endometrial Hyperplasia and Postmenopausal Women
Myomas/Adenomyosis
Sonographic Criteria to Diagnose Adenomyosis12b
Sonography in Ectopic Pregnancy
Role of Sonography in Adnexal Masses
Role of Sonographic Morphological Scores
Role of Transvaginal Color Doppler Sonography
Polyp
9:
Anesthesia for Gynecologic Laparoscopic Surgery
INTRODUCTION
ANESTHESIA FOR LAPAROSCOPY
Preoperative Assessment
Anesthesia Techniques
Local Anesthesia
Regional Anesthesia
General Anesthesia
Postoperative Care
COMPLICATIONS OF LAPAROSCOPY
Respiratory Complications
Reduced Compliance
Venous Gas Embolism
Other Infrequent Complications
Circulatory Complications
Complications due to Patient Position
Postoperative Nausea and Vomiting
SUMMARY
2: MANAGEMENT OF ADNEXAL MASSES
10:
Laparoscopic Management of Adnexal Masses
INTRODUCTION
PREOPERATIVE EVALUATION
INTRAOPERATIVE LAPAROSCOPIC EVALUATION
Algorithm for Evaluation
OPERATIVE PROCEDURES FOR BENIGN ADNEXAL MASSES
Ovarian Cystectomy
Technique (Figs 10.2 to 10.9)
Management of Endometriomas (Figs 10.10 to 10.12)
Oophorectomy/Salpingo-oophorectomy
Technique (Figs 10.13 to 10.16)
Removal of Specimen from Abdominal Cavity (Figs 10.17 to 20)
Laparoscopic Appearance of Varied Ovarian Masses
11:
Review of Laparoscopic Management of Benign Ovarian Masses
RESULTS
Primary Type of Procedure
Tumor Size by Preoperative Ultrasound
Dignity of Ovarian Tumors
Conversion Rate
Histology
DISCUSSION
Operative Techniques
Exclusion of Malignancy
Benign Teratomas
Borderline Ovarian Tumors and Ovarian Carcinoma
CONCLUSION
12:
Evaluation and Management of Ectopic Pregnancy
INTRODUCTION
EPIDEMIOLOGY
SYMPTOMS
PHYSICAL FINDINGS
DIAGNOSIS
PROGESTERONE
ULTRASOUND
ANATOMY OF THE FALLOPIAN TUBE
TREATMENT
LAPAROSCOPY
SURGICAL MANAGEMENT BASED ON LOCATION
Ampullary Ectopic Pregnancy
Isthmic Ectopic
Interstitial/Cornual Pregnancy
Ovarian Pregnancy
Cervical Pregnancy
Abdominal Pregnancy
METHOTREXATE
COMBINED MEDICAL-SURGICAL THERAPY
CONCLUSION
13:
Laparoscopic Treatment of Tubo-ovarian Abscesses
INTRODUCTION
PHYSIOPATHOLOGY
COMMON TOA, LAPAROSCOPIC TREATMENT
Methods
Medical Treatment
Resolution
Complications
Results
DISCUSSION
INTRAOVARIAN ABSCESSES
CONCLUSION
3: ENDOMETRIOSIS
14:
Peritoneal Endometriosis
PATHOPHYSIOLOGY
REVIEW OF LITERATURE
Laparoscopic Methods in Treating Endometriosis
Ovulation Suppression for Endometriosis
Peritoneal Deep Infiltrating Disease
CONCLUSION
15:
Laparoscopic Management of Endometrioma
INTRODUCTION
DIAGNOSIS
SURGERY
SURGICAL TECHNIQUE
Description of the Technique
DISCUSSION
16:
Laparoscopic Treatment of Rectovaginal Septum Adenomyosis
INTRODUCTION
MATERIALS AND METHODS
CLINICAL AND LAPAROSCOPIC ASPECTS
Clinical Aspects and Diagnosis
Laparoscopic Aspects (Table 16.2)
HISTOLOGY
SURGICAL TECHNIQUE
Long-term Results
DISCUSSION
17:
Ureteral Endometriosis: A Complication of Rectovaginal Adenomyosis
INTRODUCTION
OPERATIVE SURGERY
RESULTS
DISCUSSION
18:
Endosalpingiosis in Laparoscopy
4: INFERTILITY
19:
Laparoscopic Management of Polycystic Ovaries
MECHANISM OF ACTION
TECHNIQUES
FOLLOW-UP
Late Follow-up
MISCARRIAGE
ROLE ON HYPERANDROGENISM
METABOLIC FACTORS
CONCLUSION
20:
Laparoscopic Surgery for Infertility
GENERAL CONSIDERATION
PREOPERATIVE WORK-UP
Hysterosalpingography
Laparoscopy
Salpingoscopy
CLASSIFICATION OF TUBAL AND ADHESION SCORE
Tubal Score
Adhesion Score
Equipment
Equipment for Conventional Techniques
Technique of CO2 Laser
The Other Lasers
ADHESIOLYSIS
Indications
Special Cases
Salpingo-ovariolysis
Results
Neosalpingostomy
EVERSION OF FIMBRIA
COMPLICATIONS
RESULTS
DISCUSSION
CONCLUSION
21:
Ambulatory Surgery in Infertility
INTRODUCTION
INTRAUTERINE INTERVENTIONS
Technique
Complications
Procedures
DISCUSSION
TUBO-OVARIAN INTERVENTIONS VIA TRANSVAGINAL HYDROLAPAROSCOPY
Introduction
Technique
Procedures
Endometriosis
Ovarian Capsule Drilling
Sequelae of Pelvic Inflammatory Disease
DISCUSSION
CONCLUSION
22:
Fertiloscopy
INTRODUCTION
TECHNIQUE
Instrumentation
Fertiloscope
Room Set-up
Technique
Preparation of the Patient
Anesthesia
Introduction of the “Uterine Fertiloscope®”
Hydroperitoneum
Introduction of the “Douglas Fertiloscope®”
Use of Operative Channel
Operative Procedure
Exploration of the Pelvis (Figs 22.10 to 22.19)
The Dye Test (Figs 22.20 to 23)
Salpingoscopy (Figs 22.24 to 22.33)
Microsalpingoscopy (Figs 22.34 to 22.43)
Hysteroscopy (Figs 22.44 to 22.46)
Operative Fertiloscopy
End of the Procedure
Contraindications
DISCUSSION
5: HYSTERECTOMY
23:
Laparoscopic Assisted Vaginal Hysterectomy
INTRODUCTION
TECHNIQUE
Our Technique is Summarized in the Following Steps
Patient Positioning
Insertion of Uterine Manipulator
Verres' Needle Insertion
Trocar Insertion
Identification of the Ureters
Division of IP Ligament or Tubo-ovarian Ligament
Division of the Round Ligament
Creation of the Bladder Flap
Division of the Uterine Arteries
Vaginal Portion of LAVH
Final Inspection and Lavage
Variations in LAVH Technique
ROUTINE POSTOPERATIVE COURSE AND FOLLOW-UP
POSSIBLE COMPLICATIONS AND THEIR PREVENTION
24:
Laparoscopic Supracervical Hysterectomy
INDICATIONS
TECHNIQUE AND TECHNOLOGY
CLINICAL EXPERIENCE
DISCUSSION
25:
Total Laparoscopic Hysterectomy
CONCEPT OF TLH
Various Manipulators
Technique of TLH
Patient's Positioning
Position of Trocars
Surgical Steps
Postoperative Course
RESULTS
26:
Total Laparoscopic Hysterectomy for Large Fibroids Using the KOH Cup and Technique
SPACE FOR THE LAPAROSCOPE
CERVICAL AND INTERLIGAMENT FIBROIDS
DISSECTION END POINT: THE KOH CUP
REMOVAL OF TUMOR
Special Technical Aspects
Ports
Pitressin 1 in 30 Injection
10 mm Tenaculum
Upper Pedicles
Lower Half of TLH
The Large Awkward Uterus
Electromorcellation
Cuff Closure
CONCLUSION
27:
Laparoscopic Hysterectomy for Advanced Endometriosis
INTRODUCTION
Laparoscopic Hysterectomy
Endometriosis Hysterectomy
HYSTERECTOMY DEFINITIONS (Table 27.1)
INDICATIONS AND CONTRAINDICATIONS
Total Laparoscopic Hysterectomy Technique (TLH)
Preoperative Preparation
Incisions
Vaginal Preparation
Exploration
Surgical Technique to Excise Endometriosis
Ureteral Dissection (Optional)
The Medial Approach (Reich)
The Superior Approach
The Lateral Approach (Kadar)
Retroperitoneal Dissection
Bladder Mobilization
Upper Uterine Blood Supply
Uterine Vessel Ligation
Division of Cervicovaginal Attachments and Circumferential Culdotomy
Laparoscopic Vaginal Vault Closure and Suspension with McCall Culdoplasty
BOWEL SURGERY
Cystoscopy
Underwater Examination
Closure
POSTOPERATIVE CONSIDERATIONS
COMPLICATIONS
CONCLUSION
SUMMARY POINTS
28:
Laparoscopic Radical Hysterectomy for Early Stage Cervical Cancer
ANATOMY OF THE PELVIC VESSELS
Internal Iliac Artery
Anterior Trunk
Posterior Trunk
External Iliac Artery
LAPAROSCOPIC SURGICAL TECHNIQUES
LAPAROSCOPIC PELVIC LYMPHADENECTOMY
LAPAROSCOPICALLY ASSISTED RADICAL HYSTERECTOMY
OUR EXPERIENCE
DISCUSSION
Radical Vaginal Hysterectomy
Major Advantages in LARH
Utilizing Lee-Huang Point
Crucial Technique in LARH
Operative Steps (see Figs 28.1 to 28.19)
CONCLUSION
6: PELVIC FLOOR REPAIR
29:
Laparoscopic Paravaginal Repair and Burch Urethropexy
30:
Pelvic Reconstruction of Vaginal Apical Vault Defects Using Site-specific Repair
ANATOMY OF PELVIC SUPPORT
SURGICAL TECHNIQUE BY WAY OF LAPAROSCOPIC VAGINALVAULT SUSPENSION
31:
Management of Stress Urinary Incontinence by TVT, PVT, SPARC SLING
INTRODUCTION
32:
Current Concepts in Rectocele Repair
7: SPECIAL
33:
Microendoscopy in Gynecology
INTRODUCTION
INSTRUMENTATION
ELECTROSURGERY
SURGICAL PROCEDURES
RESULTS AND DISCUSSION
ROLE OF MICROENDOSCOPY IN CASES WITH PREVIOUS ABDOMINAL SURGERIES
COMPLICATIONS
FOLLOW-UP
CONCLUSION
34:
Laparoscopic Myomectomy
PREOPERATIVE EVALUATION
Myomectomy via Laparoscopy—The Procedure
Laparoscopic Myomectomy— Advantages and Disadvantages
Complications with Laparoscopic Myomectomy
Laparoscopic Myomectomy and Uterine Rupture during Pregnancy
Pelvic Adhesions Post-laparoscopic Myomectomy
Pregnancy and Delivery: Post-laparoscopic Myomectomy
Recurrence
SUMMARY
35:
Laparoscopic Microsurgery: Tubal Reanastomosis and Beyond
INTRODUCTION
“Classical” Microsurgery— The Evolution to ‘Gold’ Standard
Microsurgical Principles: Old and New
Laparoscopy—the Evolution
Limitations of Microsurgery via Laparotomy
The Evolution to Laparoscopic Microsurgery
Equipment for Laparoscopic Microsurgery
KOH ULTRAMICRO INSTRUMENTATION
KOH Ultramicro Needle Holder for Laparoscopic Microsurgery
Strategic Considerations for Laparoscopic Anastomosis
Technique for Laparoscopic Microsurgical Tubal Anastomosis
Results
Indications for Laparoscopic Tubal Anastomosis
Alternative Laparoscopic Techniques for Anastomosis
LAPAROSCOPIC MICROSURGERY BEYOND TUBAL ANASTOMOSIS
Microsurgical Salpingectomy
Neosalpingostomy
Ureter and Bladder
Ureteric Microdissection
Laparoscopic Management of Complications
CONCLUSIONS
8: LAPAROSCOPY IN VARIED SITUATIONS
36:
Laparoscopic Management of Chronic Pelvic Pain
INTRODUCTION
Causes of Chronic Pelvic Pain
Conscious Pain Mapping by Microlaparoscopy Under Local Anesthesia and Conscious Sedation
Laparoscopy for Chronic Pelvic Pain
Ablation of Endometriotic Implants
Treatment of Endometrial Implants
Peritoneal Implants
Superficial Peritoneal Implants
Pelvic Denervation Procedures
Anatomy of the Uterine Nerve
Laparoscopic Uterine Nerve Ablation
Presacral Neurectomy
Anatomy
Technique
Pelvic Adhesions
Role of Appendectomy
Technique of Appendectomy
Cystoscopy
Psychology vs Pathology
37:
Laparoscopy in Genital Tuberculosis
PREOPERATIVE DIAGNOSIS
MEDICAL MANAGEMENT
REVIEW OF LITERATURE
ROLE OF LAPAROSCOPY IN GENITAL TB
Acute Stage
In the Milder Forms
In the Moderate Disease
In Severe Forms
Second Look Procedure
Hysteroscopy
Technique of Lateral Metroplasty
Apart from Infertility Other Indications of Surgery
PREGNANCY AFTER PELVIC TUBERCULOSIS
38:
Laparoscopy in Pregnancy
39:
Laparoscopic Creation of Neovagina
INTRODUCTION
CONCEPT OF LAPAROSCOPIC ROUTE
AIMS OF CREATION OF NEOVAGINA
TIMING OF SURGERY
LAPAROSCOPIC TECHNIQUE OF CREATION OF NEOVAGINA
Our Instrumentation
Olive
Traction Suture
Traction Device
Vaginal Moulds
Micrograspers
Laparoscopically
Late Follow-up
RESULTS
COMPLICATIONS
Difference From Vecchietti
OTHER TECHNIQUES
CONCLUSION
40:
Hand-assisted Laparoscopy for Pelvic Surgery
HAND-ASSISTED LAPAROSCOPIC HYSTERECTOMY
Hand-assisted Laparoscopy for Pelvic Malignancy
HAND-ASSISTED LAPAROSCOPIC CHOLECYSTECTOMY AT CESAREAN SECTION
9: HYSTEROSCOPY
41:
Advanced Operative Office Hysteroscopy
INTRODUCTION
ENDOMETRIAL BIOPSIES
CASE STUDIES
RESULTS
CLINICAL DISCUSSION
BENIGN INTRAUTERINE PATHOLOGIES
CASE STUDIES
RESULTS
CLINICAL DISCUSSION
42:
Transcervical Resection of the Endometrium
43:
Endometrial Ablation
INDICATIONS FOR ENDOMETRIAL ABLATION
CANDIDATES FOR ENDOMETRIAL ABLATION
ENDOMETRIAL PREPARATION
PREOPERATIVE EVALUATION
TECHNIQUE
BRIEF WORK-UP ESSENTIAL TO MENORRHAGIA EVALUATION
CAUSES OF ENDOMETRIAL ABLATION FAILURE
CONCLUSION
44:
Thermablate ™ EAS ™ (Endometrial Ablation System)
PRE-HYSTERECTOMY CLINICAL SAFETY STUDIES
INTERNATIONAL CLINICAL STUDIES
Mumbai, India
Guangzhou, China
Canadian Studies
ILLUSTRATED CASE
45:
Hysteroscopic Myomectomy
INTRODUCTION
HYSTEROSCOPIC FINDINGS
SYMPTOMS
TECHNIQUES OF HYSTEROSCOPIC MYOMECTOMY
PREOPERATIVE ASSESSMENT
PREOPERATIVE PREPARATION
HYSTEROSCOPIC RESECTION
UTERINE DISTENSION
ELECTROSURGICAL GENERATOR (Fig. 45.6)
PATIENT POSITION
CERVICAL DILATATION
BASIC OPERATIVE TECHNIQUE
“SHORT” AND “LONG” CHIPS (Figs 45.9a to c)
HOW TO RESECT A TYPE 2 SUBMUCOUS FIBROID
CHOICE OF ANESTHESIA FOR HYSTEROSCOPIC RESECTION
INDICATIONS AND CONTRAINDICATIONS TO HYSTEROSCOPIC MYOMECTOMY
COMPLICATIONS OF SURGERY AND THEIR MANAGEMENT
CONCLUSIONS
46:
Intrauterine Adhesions (Asherman's Syndrome)
DIAGNOSIS
TREATMENT
RESULTS OF THERAPY
CLASSIFICATION OF INTRAUTERINE ADHESIONS
CONCLUSION
47:
Hysteroscopy for Metroplasty of Uterine Septa and Hypoplastic Uterus
CLASSIFICATIONS OF UTERINE MALFORMATION BY MUSSET AND THE AFS
Müllerian Aplasias
Fusion Defects
Resorption Defects
INDICATIONS AND CONTRAINDICATIONS OF UTERINE METROPLASTY
For Septate Uterus
Formal Indications
Possible Indications
Controversial Indications
Contraindications
For Hypoplastic Uterus
PREOPERATIVE WORK-UP
OPERATING ROOM SETUP
Patient
Team (Fig. 47.1)
Equipment
INSTRUMENTS
Usual Equipment (Figs 47.2 to 47.5)
ADJUSTMENT OF THE SYSTEM
Monopolar System
Bipolar System
OPERATIVE STEPS
Dilation of the Cervix
Inserting the Rectoscope
Landmarks
DIVISION OF THE SEPTATE UTERUS
Major Principles
SPECIAL CASES
End of Procedure
Postoperative Management
PROCEDURE FOR HYPOPLASTIC UTERUS
MAIN CLINICAL RESULTS FOR SEPTATE UTERUS
Our experience17
Literature Results
MAIN RESULTS FOR HYPOPLASTIC UTERUS
Our Experience32
Literature Results
COMPLICATIONS OF HYSTEROPLASTIC METROPLASTY
Mechanical Complications
Postoperative Infection
Metabolic Complications
CONCLUSION
48:
Hysteroscopic Tubal Cannulation for Proximal Tubal Block
INTRODUCTION
Classification of Tubal Blocks
ANATOMY OF PROXIMAL TUBAL REGION
Diagnosis of Proximal Tubal Occlusion
Techniques of Cannulation
Selective Salpingography
Cannulation Under Sonographic Guidance14
Hysteroscopic Tubal Cannulation
Methods of Hysteroscopic Tubal Cannulation
Flexible Guidewire through a Catheter
Cannulation Using Terumo Guidewire
Complications
Falloposcopic Guided Cannulation
Linear Eversion Cannula/ Catheter and Balloon Catheters
Results
Benefit of Hysteroscopic Cannulation
49:
Classification of Microhysteroscopic Images
HYSTEROSCOPY TECHNIQUES
CLASSIFICATION OF HYSTEROSCOPIC IMAGES
Normal Hysteroscopy
Benign Lesions
Low-risk Hyperplasia
High-risk Hyperplasia
Carcinoma
10: COMPLICATIONS OF ENDOSCOPIC SURGERY
50:
Prevention and Management of Complications of Laparoscopy
PREVENTION
Fewer the Case Load the More the Complication Rate
CONTRAINDICATIONS
PROCEDURAL FAILURES
COMPLICATIONS
Anesthesia-related Complications
Trocar-related Injuries
Results: FDA Reporting 1193–1996
Cause of Death in Fatal Trocar Injuries
Results
Results: Type of Procedures in Fatal Trocar Injuries
Visceral Injuries by Procedure
Etiology of Trocar Injuries to Abdominal Viscera
Study of Safe Abdominal Entry
Literature
Results
Results: Fatal Vascular Injuries
Results: Major Non-Fatal Vascular Injuries
Results: Bowel Injuries
Thoughts on Prevention
Conclusions
PROCEDURE RELATED
Injuries during Surgical Maneuvers: Ureter and Bladder
Small Bowel
INSTRUMENT RELATED
Electrosurgical Injuries
PATIENT RELATED
POSITIONING RELATED
CONCLUSION
51:
Complications of Hysteroscopy: Keeping Problems to a Minimum
INTRODUCTION
UNDERSTANDING THE MAGNITUDE OF COMPLICATIONS
PROCEDURE-RELATED COMPLICATIONS
IRRIGATION COMPLICATIONS
UTERINE PERFORATION COMPLICATIONS
GASEOUS COMPLICATIONS
LATE COMPLICATIONS OF HYSTEROSCOPY
INFECTIOUS COMPLICATIONS
CONCLUSIONS
INDEX
TOC
Index
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