State of the Art Atlas of Endoscopic Surgery in Infertility and Gynecology Nutan Jain
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1State of the Art Atlas of Endoscopic Surgery in Infertility and Gynecology2
3State of the Art Atlas of Endoscopic Surgery in Infertility and Gynecology
Editor Nutan Jain MBBS MS (Obs and Gyne) FICOG FICMCH Endoscopic Surgeon and Infertility Specialist Vardhman Infertility and Endoscopy Centre Muzaffarnagar India
4Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
EMCA House, 23/23B Ansari Road, Daryaganj
New Delhi 110 002, India
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State of the Art Atlas of Endoscopic Surgery in Infertility and Gynecology
© 2004 Nutan Jain
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editor and the publisher.
This book has been published in good faith that the material provided by the contributors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and editor will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters to be settled under Delhi jurisdiction only.
First Edition : 2004
9788180612657
Typeset at JPBMP typesetting unit
Printed at Gopsons Papers Ltd., A-14, Sector 60, Noida
5
This book is dedicated to my dear husband
Dr Mukesh Jain an eminent Orthopedic Surgeon.
Inspite of being extremely busy, he has strongly supported my career in Endoscopic Surgery.
It is only due to his constant encouragement that I have been able to establish an Endoscopy Centre of repute and bring out this book
6
7Contributors 11Foreword
Experience of the last 30 years has proven the value and advantages of endoscopic access for gynecologic surgery. The advantages include shortened post-operative hospital stay and recovery period; reduced post-operative discomfort (less need for analgesia); frequently lesser costs; and the ensuing medical and cosmetic gains associated with the avoidance of a laparotomy. Hysteroscopic surgery for intrauterine deformities such as uterine septa or sub-mucus fibroids eliminates the need for laparotomy as well as incision of the uterine wall. This, in comparison with traditional techniques, greatly minimizes the surgical impact on the patient.
These advantages were already recognized 30 years ago. None-the-less, the incorporation of laparoscopic and hysteroscopic surgery into daily gynecologic practice has been slow and is still far from being universally practiced at this time. In contrast, many more complex gynecological procedures can now be successfully performed by Endoscopy. The most telling of these developments has been the use of laparoscopic access for pelvic and para-aortic lymphadenectomy and radical hysterectomy for gynecologic malignancy. This I believe is the most important development of the last decade.
Progress is a continuum. Its behavior resembles that of the course of a river; this differs from phase to phase. Rapid, turbulent or relatively rapid yet smooth ones, without any specific order, may follow slow and quiet phases. In gynecology and some other surgical specialties, endoscopic access has had a rapid and relatively smooth progress in the last two decades. Thus, this is an optimal time to give an accounting of the discipline.
The book State of the Art Atlas of Endoscopic Surgery in Infertility and Gynecology is comprehensive, extensively illustrated and covers the whole field of endoscopic surgery in gynecology within its 51 chapters. Internationally recognized experts have authored each one of these chapters. The authorship reads like a list of international superstars in gynecologic surgery. Dr Nutan Jain, who has authored several chapters of the book, must be congratulated for being able to bring together in the same book such an impressive cadre of authors.
A surgical procedure is undertaken to benefit the patient. Patient safety and successful outcome are dependent upon the presence of good surgical indication, proper selection of patient and procedure, knowledge of the prerequisites, respect of the principles, and application of careful techniques by an experienced operator. I sincerely believe that this book is timely, comprehensive, and practical and provides up-to-date information in the field. I have no doubt that it will prove to be useful to its readership and enhance the surgical care for women.
Professor Victor Gomel
University of British Columbia
Faculty of Medicine
Vancouver BC
Canada12
13Preface
In this State of the Art Atlas of Endoscopic Surgery in Infertility and Gynecology, We have tried to present an entire plethora of all possible major and minor surgical procedures, which can be carried out by laparoscopy and hysteroscopy. The practice of Gynecology has undergone a sea change and the most happening field is Endoscopy. What were considered as contraindications for laparoscopic execution of certain procedures are fast becoming the indications of that particular surgery like Hysterectomy and Myomectomy for bigger fibroids. The exponential growth and awareness of this unique modality both amongst practicing gynecologists and patients has been instrumental in establishing minimal access surgery. This Atlas encompasses the description of most of the surgeries with the help of high quality color illustrations serially depicting the surgical steps. The main aim is to give full textual knowledge, profusely supported by color prints and latest references to further enhance the scientific contents.
The first section adequately covers the Basic OR Set-up, instrumentation and OR layout for major Laparoscopic and Hysteroscopic procedures. No surgery can proceed without adequate knowledge of anatomy and this is most true of laparoscopic surgery. Keeping this in mind there is a chapter dedicated to Laparoscopic Pelvic Anatomy. Laparoscopic Hemostasis is discussed in most lucid manner covering the basics of Electrosurgery, harmonics, lasers and mechanical means like staples and clips. No surgery can be successful without the preoperative workup and laparoscopy replete with its inability of palpation makes it an apt case for thorough preoperative screening. This is covered in the chapter, Correlation of Endosonography Endoscopic Surgery. Techniques and risks of anesthesia have been adequately discussed.
A complete chapter is dedicated to laparoscopic suturing keeping in mind that “Today's empowerment in suturing skill paves the way for tomorrow's success”. Laparoscopic tissue retrieval has been addressed in a complete chapter. Most important aspect of laparoscopy, adhesion prevention has been well elaborated. The section on Adnexal masses includes all techniques and a review of laparoscopic management of Adnexal masses. A very exhaustive chapter on ectopic pregnancy has been included. In keeping with the modern rising trends of tubo-ovarian abscess a complete chapter has been dedicated to it.
Hysterectomy the most frequently performed surgery the world over has been very adequately addressed. All possible modalities like LAVH, supracervical, total laparoscopic hysterectomy, difficult hysterectomy with advanced endometriosis hysterectomy for large size uterus and radical hysterectomy have all been given detailed text and pictoral coverage. It will be a delightful enrichment for the reader.
Keeping in mind the widespread incidence of endometriosis and laparoscopy emerging as ‘Gold standard’, a full section has been dedicated to the management of different types of endometriosis by the pioneers in this field. An interesting and increasingly recognized ‘entity’, Endosalpingiosis has also been included to help students and established practitioners to distinguish and appreciate it.
Laparoscopic Myomectomy a very widely accepted procedure, which has stood the test of time, has been covered to the last detail. Adding to the diversity of this section is the latest trend of laparoscopic microsurgery highlighting tubo-tubal reanastomosis. Microlaparoscopy with use of 2 mm smaller scopes has been covered in a separate chapter.
A section on infertility encompasses the laparoscopic management of tubal factor infertility, laparoscopic surgical management of polycystic ovaries and ambulatory surgery in the practice of infertility. A very meticulous presentation of “Fertiloscopy” will be highly appreciated.
Pelvic floor repair a very recent and upcoming surgical modality by the laparoscopic route has been covered to the minutest detail. The balance of text and pictorial description has been maintained throughout the book. All accepted trends like laparoscopic Burch and paravaginal repair, management of Entrocele, vault prolapse and newer introductions like TVT, PVT, SPARC SLING and management of Rectocele have been included to add greater value to the contents.14
A special section has been created to cover diverse surgical techniques in varied situations encompassing laparoscopy in pregnancy, genital tuberculosis, chronic pelvic pain and hand-assisted laparoscopy for very big pelvic masses. Recent innovations like laparoscopic creation of Neovagina have also been included to give an insight into the far varied applications of minimal access surgery.
No description of surgeries is complete without addressing their complications and management. To enable this a complete chapter by the pioneers in this field has been included.
The other arm of endoscopic surgery, hysteroscopy has also been adequately covered by describing the various surgeries that could be carried out by this route. The trend of adequate theoretical coverage with good number of surgical illustrations and color photographs has been well maintained throughout this section. It addresses office operative hysteroscopy, management of submucous myomas, septal resection, management of intrauterine synechiae, uterotubal cannulations, management of menorrhagia by TCRE, roller ball thermal ablation all of which add to the diversity of this section. Again, a very balanced description of complications and fluid management during operative hysteroscopy has been incorporated.
This atlas, with its richness of texts, references and color photographs promises to be a most versatile and comprehensive coverage of all major and minor laparoscopic and hysteroscopic procedures. An asset to any library.
Nutan Jain
15Acknowledgements
It has been such a pleasure planning, working, executing and finally bringing out this State of the Art Atlas of Endoscopic Surgery in Infertility and Gynecology. Right from inception to the final completion, it has been a great learning experience. Though science knows no boundaries, interacting and working with so many renowned endoscopic surgeons from around the globe has been an immemorable experience. It gave enormous insight into human behavior, differences in ethnic, linguistic and cultural practices, but the one thing that remained common was their commitment to Endoscopic Surgery. The keen desire to promote and propagate safe practices of Endoscopic Surgery was the common platform they shared, which brought them together. It was my endeavor to bring forth a book containing the best possible expertise from around the world.
I express my heartfelt gratitude to all contributing authors, pioneers in their specific fields who despite their busy schedules put in their best efforts to compile chapters of immense scientific value. Their valuable suggestions, constructive criticism and words of encouragement during the compilation of the book went a long way in keeping me motivated towards this task. Their valuable contributions collectively have taken the shape of a fine textbook, which will enlighten budding and established endoscopists alike to the intricacies of Advanced Endoscopic Surgery.
I take this opportunity to express my sincere gratitude to all my teachers, who taught me, nurtured my skills and enabled me to work for the cause of Endoscopic Surgery.
I profusely thank the Publishers M/s Jaypee Brothers Medical Publishers (P) Ltd. and especially Jitendar Pal Vij, Mr Nitin Goyal, Mr Tarun Duneja and their efficient team. They put in tremendous efforts to bring out this book timely and to give it excellent print and picture quality. It was a pleasant experience working with them.
My sincere thanks to dear friends like Mrs and Dr Kame, Mrs and Dr Gada, Mrs and Dr Dilip Pal, Mrs and Dr Narayana Hegde, Mrs and Dr Sunil Ahuja, Mrs and Dr Satish Bhutani, Dr Ishwar Chandra, Dr Sunil Gupta Dr Suchi Kushwaha, Dr Vinod Kushwaha, Dr Jitendra Maheshwari, Dr Vineet Jain and Rakesh Nath. It is their continued support, which has been instrumental in bringing out this book.
I sincerely thank my own hospital staff especially Mr. Ashish and Vishram whose untiring help through out the compilation of this book was of immense value. I would like to mention Dr Meenakshi Kanwar and Dr Vartika Agarwal for providing digital images from the surgical cases and helping in compiling various chapters, Alpa Tyagi who helped me with providing the hospital statistics has been a great help all through.
I would like to acknowledge the “Infometry Solutions” for providing a superb computer software for capturing and transfering digital images of surgical proceedings. I especially thank Mr Anirudh for helping us out.
I would like to thank Mr Peter Laser, managing director of M/s Karl Storz in India and his efficient team for their all time support.
I greatly appreciate the wholehearted support of all my family members. My parents have been a great source of inspiration for me. My husband Dr Mukesh and children, Mansi and Anubhav have in their capacity been extremely caring and helpful and never complaining about the lesser time spent with them. Their unwavering support helped me tide over the difficult phases during the compilation of this book. I would especially mention late Dr PC Jain a learned scholar who had inspired me in his life time to come out with a book on Endoscopic Surgery.
In the end I thank all my patients who have posed faith in me and in this newer modality of “Endoscopic Surgery”. If I can ensure better patient care through safe propagation of Minimal Access Surgery by means of this Atlas it will be the ultimate fulfillment of a cherished dream.