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State of the Art Atlas of Endoscopic Surgery in Infertility and Gynecology
Nutan Jain
SECTION 1: GENERAL
CHAPTER 1:
OR Set-up and Basic Instrumentation for Gynecological Endoscopy
INTRODUCTION
Laminar Flow System
Stryker Modular Operating Suite at Vardhman Laparoscopy Centre
Documentation and Image Capture
Teaching and Training Facilities
EDUCATION AND TRAINING
ACKNOWLEDGMENT
CONCLUSION
CHAPTER 2:
Laparoscopic Retroperitoneal Anatomy
INTRODUCTION
SUPERFICIAL INTRAPERITONEAL ANATOMY (Landmarks to Retroperitoneal Structures—Figs 2.1a to e)
PELVIC BRIM (Figs 2.2 and 2.3)
PELVIC SIDEWALL (Figs 2.4a to i)
Pelvic Lymph Nodes
BASE OF THE BROAD LIGAMENT (Figs 2.5a and b)
AVASCULAR SPACES OF THE PELVIS (Figs 2.6a and b)
Space of Retzius (Figs 2.7a to c)
Paravesical Space (Fig. 2.8a)
Pararectal Space (Figs 2.8b and c)
Vesicovaginal and Rectovaginal Spaces (Figs 2.9a to c, Figs 2.10a and b)
Presacral and Retrorectal Space (Figs 2.11a to e)
THE PARA-AORTIC REGION (Figs 2.12a to f)
THE URETER (Figs 2.1e, 2.2, 2.12e and f, 2.13a and b)
CHAPTER 3:
Laparoscopic Access
INTRODUCTION
ACCESS INSTRUMENTS
Port Dynamics during Laparoscopy
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
CHAPTER 4:
Laparoscopic Cutting and Hemostasis
INTRODUCTION
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
CHAPTER 5:
“1, 2 and V,” Laparoscopic Suturing Simplified to the Core
INTRODUCTION
EQUIPMENTS
Needle Holders
Now We shall Describe Our Simplified Technique
Choice of Needle
Loading the Needle
Aligning the Needle
Loading the Needle
Making the Knot
CONCLUSION
CHAPTER 6:
Laparoscopic Tissue Retrieval
INTRODUCTION
Using Bigger Ports
Colpotomy
USE OF ENDOBAGS
ELECTROMECHANIC MORCELLATION
ENDOSCOPIC KNIFE FOR SUBTOTAL HYSTERECTOMY AND MORCELLATION
CHAPTER 7:
Laparoscopic Adhesion Prevention
INTRODUCTION
CHAPTER 8:
Correlation of Endosonography and Endoscopic Surgery
INTRODUCTION
HYSTEROSCOPY AND SONOGRAPHY
Submucous Myomas
Endometrial Hyperplasia and Postmenopausal Women
Myomas/Adenomyosis
Sonographic Criteria to Diagnose Adenomyosis15
Sonography in Ectopic Pregnancy
Role of Sonography in Adnexal Masses
Role of Sonographic Morphological Scores
Role of Transvaginal Color Doppler Sonography
Ovarian Cancer: What Does 3D Ultrasound Offer?
Advantages of 3D Power Doppler Imaging
More Accurate Diagnosis of Ovarian Cancer
The Detection of Stage I Disease
Role of Sonography for Deep Endometriosis
CHAPTER 9:
Anesthesia for Gynecologic Laparoscopic Surgery
INTRODUCTION
ANESTHESIA FOR LAPAROSCOPY
Preoperative Assessment
Anesthesia Techniques
Local Anesthesia
Regional Anesthesia
General Anesthesia
Postoperative Care
IMPORTANT ANESTHETIC CONSIDERATIONS
Respiratory Complications
Reduced Compliance
Venous Gas Embolism
Other Infrequent Complications
Circulatory Complications
Patient Position
Obesity
Postoperative Benefits and Consequences of Laparoscopy
Postoperative Pain
Pulmonary Dysfunctions
Postoperative Nausea and Vomiting
Complication of Laparoscopy
SUMMARY
SECTION 2: MANAGEMENT OF ADNEXAL MASSES
CHAPTER 10:
Laparoscopic Management of Adnexal Masses
INTRODUCTION
PREOPERATIVE EVALUATION
Imaging
Tumor Markers
INTRAOPERATIVE LAPAROSCOPIC EVALUATION
OPERATIVE PROCEDURES FOR BENIGN ADNEXAL MASSES
Ovarian Cystectomy (Figs 10.3 to 10.5)
Technique (Figs 10.6a to d)
Oophorectomy/Salpingo-oophorectomy (Figs 10.8a to c)
Management of Endometriomas (Figs 10.9a to c)
Management of Endometriomas (Figs 10.10a to 10.11d)
Technique (Figs 10.12a to d and 10.15)
Removal of Specimen from Abdominal Cavity (Figs 10.16 to 10.18)
Methods
Pelvic Adhesions and Distorted Anatomy
CHAPTER 11:
Review of Laparoscopic Management of Benign Ovarian Masses
INTRODUCTION
Procedure Assignment
Operative Procedures
Intraoperative Diagnosis
Screening Tests
Vaginal Examination
Tumor Markers
Ultrasound
Color Doppler
Other Imaging Modalities
Multimodal Approach
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
CHAPTER 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 (Figs 12.8a to c)
Salpingectomy
Cervical Pregnancy (Figs 12.9a and b)
Ectopic Pregnancy with Rudimentary Horn
Abdominal Pregnancy
METHOTREXATE
COMBINED MEDICAL-SURGICAL THERAPY
CONCLUSION
CHAPTER 13:
Laparoscopic Treatment of Tubo-ovarian Abscesses
INTRODUCTION
PHYSIOPATHOLOGY
COMMON TOA, LAPAROSCOPIC TREATMENT
Methods
Medical Treatment
Resolution
Complications
Results
Long-term Follow-up4
Results on Fertility
DISCUSSION
INTRAOVARIAN ABSCESSES
CONCLUSION
SECTION 3: ENDOMETRIOSIS
CHAPTER 14:
Peritoneal Endometriosis
INTRODUCTION
PATHOPHYSIOLOGY
REVIEW OF LITERATURE
Laparoscopic Methods in Treating Endometriosis
Ovulation Suppression for Endometriosis
Peritoneal Deep Infiltrating Disease
CONCLUSION
CHAPTER 15:
Laparoscopic Management of Endometrioma
INTRODUCTION
DIAGNOSIS
SURGERY
Surgical Technique
Description of the Technique
DISCUSSION
CHAPTER 16:
Laparoscopic Excision of Rectovaginal Septum Adenomyosis
INTRODUCTION
DIAGNOSIS
Evaluation
Bimanual Pelvic Examination
Ultrasonography
TREATMENT OPTIONS
Medical Management
Surgical Management
TECHNIQUE OF LAPAROSCOPIC RADICAL EXCISION
Aim of Surgery
Surgical Technique
Preparation at the Vaginal End (Figs 16.8a, c and d)
Mode of Surgery used for Dissection
Exact Surgical Technique
ABLATION OF ENDOMETRIOTIC IMPLANTS
ADHESION PREVENTION
POSTOPERATIVE COURSE
RESULTS
CONCLUSION
CHAPTER 17:
Surgical Treatment of Deep Infiltrating Endometriosis
INTRODUCTION
THERAPEUTIC ASPECTS OF ENDOMETRIOSIS OF THE URINARY TRACT
Bladder Endometriosis
Endometriosis Affecting the Ureter
THERAPEUTIC ASPECTS OF RETROCERVICAL AND BOWEL ENDOMETRIOSIS
CONCLUSION
CHAPTER 18:
Endosalpingiosis in Laparoscopy
INTRODUCTION
Etiology
Microscopic Findings
Macroscopic Findings
Clinical Significance (Table 18.2)
EDS and Malignancy
Therapy of Endosalpingiosis
SECTION 4: INFERTILITY
CHAPTER 19:
Laparoscopic Management of Polycystic Ovaries
INTRODUCTION
MECHANISM OF ACTION
TECHNIQUES
FOLLOW-UP
LATE FOLLOW-UP
MISCARRIAGE
ROLE ON HYPERANDROGENISM
METABOLIC FACTORS
CONCLUSION
CHAPTER 20:
Laparoscopic Surgery for Infertility
INTRODUCTION
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
Adhesion Prevention
Management of Hydrosalpinx
DISCUSSION
CONCLUSION
CHAPTER 21:
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 21.10 to 21.19)
The Dye Test (Figs 21.20 to 21.23)
Salpingoscopy (Figs 21.24 to 21.33)
Microsalpingoscopy (Figs 21.34 to 21.43)
Hysteroscopy (Figs 21.44 to 21.46)
Operative Fertiloscopy
End of the Procedure
Contraindications
MICROSALPINGOSCOPY OVERVIEW (Figs 21.34 to 21.43)
DISCUSSION
Ovarian Drilling (Figs 21.47 to 21.50)
Adhesiolysis (Fig 21.51 to 22.54)
SECTION 5: HYSTERECTOMY
CHAPTER 22:
Laparoscopic Assisted Vaginal Hysterectomy
INTRODUCTION
TECHNIQUE
Our Technique is Summarized in the Following Steps
Patient Positioning
Insertion of Uterine Manipulator
Veress 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
CHAPTER 23:
Laparoscopic Supracervical Hysterectomy
INTRODUCTION
INDICATIONS
TECHNIQUE AND TECHNOLOGY
CLINICAL EXPERIENCE
DISCUSSION
CONCLUSION
CHAPTER 24:
Total Laparoscopic Hysterectomy
INTRODUCTION
CONCEPT OF TLH
Concept of TLH
Various Manipulators
TECHNIQUE OF TLH
Patient's Positioning
Energy Source
Position of Trocars
SURGICAL STEPS
Technique of TLH
Technique of TLH
Colpotomy
Laparoscopic Vault closure
Postoperative Course
TLH IN DIFFICULT SITUATIONS
Multiple Previous Cesarean Section (Figs 24.8a to d)
Obese Patients
RESULTS
CHAPTER 25:
Total Laparoscopic Hysterectomy for Large Fibroids Using the KOH Colpotomizer and Technique
RECAPITULATION OF THE STANDARD TECHNIQUE FOR TOTAL LAPAROSCOPIC HYSTERECTOMY
List of Instruments for Standard Laparoscopic Hysterectomy
SPACE FOR LAPAROSCOPE
CERVICAL AND INTERLIGAMENT FIBROIDS
DISSECTION ENDPOINT: THE KOH COLPOTOMIZER
REMOVAL OF FIBROIDS
SPECIAL TECHNICAL ASPECTS
Ports
Pitressin Injection (1 in 30 Dilution)
10 mm Tenaculum
Upper Pedicles
Lower Half of Total Laparoscopic Hysterectomy
The Large “Awkward” Uterus
Electro-morcellation
Cuff Closure
CONCLUSION
CHAPTER 26:
Hysterectomy for Advanced Endometriosis and Bowel Resection Anastomosis
INTRODUCTION
Laparoscopic Hysterectomy
Endometriosis Hysterectomy
HYSTERECTOMY DEFINITIONS (Table 26.1)
Diagnostic Laparoscopy with Vaginal Hysterectomy
Laparoscopic Assisted Vaginal Hysterectomy (LAVH)
Laparoscopic Hysterectomy (LH)
Total Laparoscopic Hysterectomy (TLH)
Laparoscopic Supracervical Hysterectomy (LSH)
INDICATIONS AND CONTRAINDICATIONS
TOTAL LAPAROSCOPIC HYSTERECTOMY TECHNIQUE (TLH)
Preoperative Preparation
Incisions
Vaginal Preparation
Exploration
Surgical Technique to Excise Endometriosis (Figs 26.1 to 26.16)
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 (Figs 26.17 to 26.23)
BOWEL SURGERY (Figs 26.24 to 26.50)
Anterior Discoid Rectal Resection
Cystoscopy
Underwater Examination
Closure
Postoperative Considerations
Complications
CONCLUSION
SUMMARY POINTS
CHAPTER 27:
Laparoscopic Radical Hysterectomy of “The Pune-Techniques”
INTRODUCTION AND HISTORY
Patient Selection and Preoperative Assessment
PROCEDURE
Step 1: Posterior U Cut
Step 2: Dissection of Rectovaginal Space
Step 3: Dissection of Pararectal Space
Step 4: Anterior U Cut
Step 5: Dissection of Ureteric Tunnel
Step 6: Lymph Node Dissection
POSTOPERATIVE MANAGEMENT
RESULTS
DISCUSSION
COMPLICATIONS AND THEIR MANAGEMENT
Intraoperative
Postoperative
CONCLUSION
SECTION 6: PELVIC FLOOR REPAIR
CHAPTER 28:
Laparoscopic Paravaginal Repair and Burch Urethropexy
INTRODUCTION
Equipments and Sutures
POTENTIAL COMPLICATIONS AND INJURIES
Lower Urinary Tract Injuries
Vascular Injuries
CONCLUSION
CHAPTER 29:
Laparoscopic Sacral Colpopexy and Enterocele Repair with Mesh
INTRODUCTION
ANATOMY OF PELVIC SUPPORT
Endopelvic Fascia
LEVEL I—APICAL SUPPORT
LEVEL I SUPPORT—LAPAROSCOPIC APPROACH TO ENTEROCELE REPAIR AND VAGINAL VAULT SUSPENSION
Site-specific Enterocele Repair and Vaginal Vault Suspension
Laparoscopic Enterocele Repair
Laparoscopic Sacral Colpopexy
Potential Complications and Injuries
Lower Urinary Tract Injuries
Bowel Injury
Vascular Injuries
LEVEL I SUPPORT PROCEDURES: CLINICAL RESULTS
CONCLUSION
CHAPTER 30:
Contemporary Modern Management of Stress Urinary Incontinence
INTRODUCTION
TRANSOBTURATOR ANATOMY (Figs 30.71a and b)
TOT NEEDLE PASSAGE (Figs 30.72A to 30.73)
TOT MIMICS NORMAL ANATOMY
CLINICAL OUTCOMES
OUTSIDE-IN IS SAFER THAN INSIDE-OUT APPROACH
TIPS AND PEARLS (RARE COMPLICATIONS)
TVT Needle Passage
SPARC Needle Passage Technique
MONARC Needle Passage
TOT Needle Passage
CONCLUSION
CHAPTER 31:
Current Concepts in Rectocele Repair
INTRODUCTION
PHYSICAL EXAMINATION
DIAGNOSTIC TESTING
SURGICAL MANAGEMENT
Posterior Colporrhaphy
Site-Specific Defect Repair
Graft Augmentation
Sacral Colpopexy (Colpoperineopexy)
Laparoscopic Rectocele Repair
Perineorrhaphy
Postoperative Instructions
Complications
Sexual Function and Posterior Repair
CONCLUSIONS
SECTION 7: SPECIAL
CHAPTER 32:
Contemporary Approach to Laparoscopic Myomectomy
INTRODUCTION
PREOPERATIVE EVALUATION
Myomectomy via Laparoscopy—The Procedure
Laparoscopic Myomectomy—Advantages and Disadvantages
Complications with Laparoscopic Myomectomy
Pelvic Adhesions Post-laparoscopic Myomectomy
Pregnancy and Delivery: Post-laparoscopic Myomectomy
Laparoscopic Myomectomy and Uterine Rupture during Pregnancy
Pelvic Pain and Abnormal Uterine Bleeding Status Post-myomectomy
Recurrence
Laparoscopic Myomectomy Utilizing Robotics
SUMMARY
CHAPTER 33:
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 Considerationsfor Laparoscopic Anastomosis
Technique for Laparoscopic Microsurgical Tubal Anastomosis
Results
Indications for Laparoscopic Tubal Anastomosis
Alternative Laparoscopic Techniques for Anastomosis
LAPAROSCOPIC MICROSURGERYBEYOND TUBAL ANASTOMOSIS
Microsurgical Salpingectomy
Neosalpingostomy
Ureter and Bladder
Ureteric Microdissection
Laparoscopic Management of Complications
CONCLUSIONS
SECTION 8: LAPAROSCOPY IN VARIED SITUATIONS
CHAPTER 34:
Laparoscopic Management of Chronic Pelvic Pain
INTRODUCTION
Causes of Chronic Pelvic Pain
Conscious Pain Mapping by Microlaparoscopy Under Local Anesthesiaand Conscious Sedation
Laparoscopy for Chronic Pelvic Pain
Ablation of Endometriotic Implants
Narrow Band Technique
Treatment of Endometrial Implants
Peritoneal Implants
Superficial Peritoneal Implants
Appearances
Complete Treatment of Endometriosis
Pelvic Denervation Procedures
Peritoneal Endometriosis
Anatomy of the Uterine Nerve
Laparoscopic Uterine Nerve Ablation
Presacral Neurectomy
Anatomy of Presacral Nerve
Technique
Anatomy of Presacral Space
Pelvic Adhesions
Presacral Neurectomy
Role of Appendectomy
Technique of Appendectomy
Cystoscopy
Psychology vs Pathology
CHAPTER 35:
Laparoscopy in Genital Tuberculosis
INTRODUCTION
PREOPERATIVE DIAGNOSIS
Clinical Presentation
Physical Examination
Treatment
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
Surgical Management of Caseous Ball
Hysteroscopy
Technique of Lateral Metroplasty
PREGNANCY AFTER PELVIC TUBERCULOSIS
Results
CHAPTER 36:
Laparoscopy in Pregnancy
INTRODUCTION
FACTORS TO BE CONSIDERED
ADVANTAGES OF LAPAROSCOPY IN PREGNANCY
RISKS OF LAPAROSCOPY IN PREGNANCY
TIME TO PERFORM SURGERY IN PREGNANCY
PROCEDURE
APPENDECTOMY IN PREGNANCY
LAPAROSCOPIC CHOLECYSTECTOMY
LAPAROSCOPIC TREATMENT OF HETEROTOPIC PREGNANCY
Laparoscopy in Bleeding Ectopic Pregnancy
LAPAROSCOPY FOR ADNEXAL MASS
LAPAROSCOPY FOR ADNEXAL TORSION
LAPAROSCOPIC ABDOMINAL CERCLAGE
CHAPTER 37:
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
SECTION 9: RECENT ADVANCES
CHAPTER 38:
Hand-assisted Laparoscopy for Pelvic Surgery
INTRODUCTION
HAND-ASSISTED LAPAROSCOPY TECHNIQUE
Incision and Port Placement
HAND-ASSISTED LAPAROSCOPIC MYOMECTOMY
HAND-ASSISTED LAPAROSCOPICHYSTERECTOMY
HAND-ASSISTED LAPAROSCOPYFOR PELVIC MALIGNANCY
HAND-ASSISTED LAPAROSCOPIC CHOLECYSTECTOMY AT CESAREAN SECTION
CHAPTER 39:
Cosmetogynecology
INTRODUCTION
MONS PUBIS
LABIA MAJORA
Labia Majora Volume Enhancement with Autologous Fat Transfer
Labia Majora Reduction
Labia Majora Convergence
VARICOSE VEINS
LABIA MINORA
THE CLITORAL REGION
VAGINAL TIGHTENING
HYMEN RESTORATION
CONCLUSION
CHAPTER 40:
The Evolving Role of Robotics in Reproductive Gynecologic Surgery
INTRODUCTION
THE BIRTH OF SURGICAL ROBOTICS
ROBOTIC INSTRUMENTATION
TUBAL REANASTOMOSIS
MYOMECTOMY
CONCLUSION
CHAPTER 41:
Natural Orifice Transluminal Endoscopic Surgery
INTRODUCTION
CLINICAL APPLICATION
INSTRUMENTS USED
TECHNIQUE OF NOTES
Transgastric Approach
Preoperative Preparation
Gastrotomy
Appendectomy (Figs 41.1a to d)
Transgastric Tubal Occlusion (Figs 41.2a and b)
Gastrotomy Closure
Transvaginal Approach
PITFALLS
SUGGESTED POINTS FOR A BEGINNER
COMPLICATIONS AND REMEDIAL STEPS
CHAPTER 42:
Single Port Access Surgery
INTRODUCTION
ACKNOWLEDGMENT
SECTION 10: HYSTEROSCOPY
CHAPTER 43:
Advanced Operative Office Hysteroscopy - 2010
INTRODUCTION
THE VAGINOSCOPICAL APPROACH
EVALUATION OF THE UTERINE CAVITY
ENDOMETRIAL BIOPSIES
Case Studies
Results
Clinical Discussion
BENIGN INTRAUTERINE PATHOLOGIES
Case Studies
Results
ADVANCED BIPOLAR SURGERY
Case Studies
Results
Clinical Discussion
OPPIUM TECHNIQUE
Case Studies
Results
Clinical Discussion
OFFICE HYSTEROSCOPIC METROPLASTY
Case Studies
Appearance of Various Pathologies on Office Hysteroscopy
Results
Clinical Discussion
CHAPTER 44:
Transcervical Resection of the Endometrium
INTRODUCTION
HISTORY OF TCRE
THE EFFICACY OF TCRE, AND COMPARISON WITH OTHER TREATMENTS
PATIENT SELECTION
CONTRACEPTION COUNSELING
PREOPERATIVE ENDOMETRIAL PREPARATION
ANESTHESIA
ANTIBIOTIC PROPHYLAXIS
PROCEDURE OF TCRE
COMPLICATIONS
SUMMARY
CHAPTER 45:
Endometrial Ablation
INTRODUCTION
Overview of Resectoscopic Techniques
Overview of Nonresectoscopic Devices
CLINICAL APPLICATION
Indications and Contraindications
Preoperative Evaluation
Pretreatment
Efficacy and Clinical Outcomes
Special considerations
INSTRUMENTS REQUIRED
Equipment for Resectoscopic Techniques
Equipment for Nonresectoscopic Techniques
Exact Technique
Resectoscopic Techniques
Nonresectoscopic Techniques
HELPFUL HINTS
COMPLICATIONS
Distention Media Fluid Overload
Uterine Trauma
Thermal Injury
Scarring
Post-ablation-tubal Sterilization Syndrome
Pregnancy
Endometrial Malignancy
Infection
CONCLUSION
CHAPTER 46:
Hysteroscopic Myomectomy
INTRODUCTION
HYSTEROSCOPIC FINDINGS
PRESENTATION
DIAGNOSIS
CLASSIFICATION OF SUBMUCOUS FIBROIDS
INDICATIONS AND CONTRAINDICATIONS FOR HYSTEROSCOPIC MYOMECTOMY
PREOPERATIVE ASSESSMENT
HYSTEROSCOPIC MYOMECTOMY
RESECTOSCOPE
TECHNIQUE OF HYSTEROSCOPIC RESECTION OF SUBMUCOUS FIBROID
Cervical Dilatation
Basic Operative Technique
Technique of Resection Deeper (Type II) Submucous Fibroids
“Short” and “Long” Chip Techniques
LASER HYSTEROSCOPIC MYOMECTOMY
VERSAPOINT
THE MINI-RESECTOSCOPE
OPERATIVE COMPLICATIONS OF HYSTEROSCOPIC MYOMECTOMY
LONG-TERM EFFECTS OF HYSTEROSCOPIC MYOMECTOMY
Abnormal Uterine Bleeding
Fertility
CONCLUSIONS
CHAPTER 47:
Intrauterine Adhesions (Asherman′s Syndrome)
INTRODUCTION
DIAGNOSIS
TREATMENT
RESULTS OF THERAPY
CLASSIFICATION OF INTRAUTERINE ADHESIONS
CONCLUSION
CHAPTER 48:
Hysteroscopy for Metroplasty of Uterine Septa and Hypoplastic Uterus
INTRODUCTION
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. 48.1)
Equipment
INSTRUMENTS
Usual Equipment (Figs 48.2 to 48.5)
ADJUSTMENT OF THE SYSTEM
Monopolar System
Bipolar System
OPERATIVE STEPS
Dilatation 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 Experiences17
Résults
Discussion
CONCLUSION
Literature Results
MAIN RESULTS FOR HYPOPLASTIC UTERUS
Our Experience39
Literature Results
COMPLICATIONS OF HYSTEROPLASTIC METROPLASTY
Mechanical Complications
Postoperative Infection
Metabolic Complications
CONCLUSION
CHAPTER 49:
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 and Contraindications
Falloposcopic Guided Cannulation
Linear Eversion Cannula/Catheter and Balloon Catheters
Results
Benefit of Hysteroscopic Cannulation
CHAPTER 50:
Classification of Microhysteroscopic Images
INTRODUCTION
HYSTEROSCOPY TECHNIQUES
CLASSIFICATION OF HYSTEROSCOPIC IMAGES
Normal Hysteroscopy
Benign Lesions
Low-risk Hyperplasia
High-risk Hyperplasia
Carcinoma
CONCLUSIONS
SECTION 11: COMPLICATIONS OF ENDOSCOPIC SURGERY
CHAPTER 51:
Prevention and Management of Complications of Hysteroscopy
INTRODUCTION
UNDERSTANDING THE MAGNITUDE OF COMPLICATIONS
PROCEDURE-RELATED COMPLICATIONS
IRRIGATION COMPLICATIONS
UTERINE PERFORATION COMPLICATIONS
GASEOUS COMPLICATIONS
LATE COMPLICATIONS OF HYSTEROSCOPY
INFECTIOUS COMPLICATIONS
CONCLUSIONS
CHAPTER 52:
Prevention and Management of Complications of Laparoscopy
INTRODUCTION
COMPLICATIONS
Anesthesia
Positioning
Trocar-related Injuries
Primary Trocar Entry
Accessory Trocar Placement
Vascular Injury
Abdominal Wall Vessels
Major Vessels
Bowel Injury
Repair of Rectal Injury
Urinary Tract Injuries
Bladder Injuries
Repair of Rectal Injury
Ureteral Injuries
Ureteral Injury Repair
CONCLUSION
INDEX
TOC
Index
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