Jaypee Brothers
In Current Chapter
In All Chapters
X
Clear
X
GO
Normal
Sepia
Dark
Default Style
Font Style 1
Font Style 2
Font Style 3
Less
Normal
More
A Manual of Minimally Invasive Gynecological Surgery
Liselotte Mettler, Ibrahim Alkatout, Meenu Agarwal
SECTION 1: TO KNOW YOUR BASICS
CHAPTER 1:
Equipment in Laparoscopic Surgery
INTRODUCTION
LAPAROSCOPY VERSUS OPEN SURGERY
IMAGING DEVICES
Laparoscopic Camera
Video Monitors
Video Recording Systems
CO2 GAS INSUFFLATOR
PORTS OF ENTRANCE IN ABDOMINAL CAVITY
Veress Needle
Trocars
INSTRUMENTS
CHAPTER 2:
Peritoneal Access in Laparoscopy
INTRODUCTION
LAPAROSCOPIC PERITONEAL PORT FUNDAMENTALS
CLASSIFICATION OF LAPAROSCOPIC ACCESS METHODS
CLOSED CONVENTIONAL LAPAROSCOPIC ACCESS METHOD
Access Principles
HIGH PRESSURE LAPAROSCOPIC ACCESS METHOD
RADIALLY EXPANDING LAPAROSCOPIC ACCESS METHOD
DIRECT LAPAROSCOPIC ACCESS METHOD
OPEN LAPAROSCOPIC ACCESS METHOD
VISUAL LAPAROSCOPIC ACCESS METHOD
CLOSED Laparoscopic Access with the Threaded Visual Cannula: EndoTIP™
OPEN Laparoscopic Access with the Threaded Visual Cannula: EndoTIP™
Ancillary Laparoscopic Access with the Visual Threaded Cannula: EndoTIP™
SINGLE-PORT LAPAROSCOPIC ACCESS WITH THE THREADED VISUAL CANNULA ENDOCONE™
LAPAROSCOPIC ACCESS SITES
LAPAROSCOPIC ACCESS INSTRUMENTS
CONCLUSION
CHAPTER 3:
Port Placement in Laparoscopy
INTRODUCTION AND OUTLINE
COUNSELING AND INFORMED CONSENT
EXTRA-ABDOMINAL RELEVANT ANATOMY
Relevant Anatomy
Places for Trocar Insertion
INTRA-ABDOMINAL RELEVANT ANATOMY THROUGH THE EYE OF THE TROCAR
Anatomical Landmarks
Places for Trocar Insertion
PORTS AND TROCARS
Development of Ports and Trocars
Types of Ports and Trocars
Disposable versus Reusable Trocars
Disposable Trocars
Reusable Trocars
ENTRY TECHNIQUES
Brief Manual of Port Placement
Prearrangement Before Creation of the Pneumoperitoneum
Creation of the Pneumoperitoneum
Obese Patients
Very Thin Patients
Patients with Previous Laparoscopies or Laparotomies
Patients with Previous Failed Insufflations
Open Entry Technique
Advantages and Disadvantages of Open Laparoscopy (Hasson Technique)
Technique of Open Entry
Closed Entry Technique
Veress Needle Technique and CO2 Gas
Direct Blind Entry
Entry Under Vision
VAGINAL INSTRUMENTS
Uterus Manipulator
ADVANCEMENTS IN LAPAROSCOPIC ENTRIES
Single-port Entry
ALTERNATIVE ENTRY SITES
Subcostal Insufflation Technique (Palmer's Point)
Insertion Technique
Transuterine Insufflation
Transdouglas Insufflation
TROCAR PLACEMENT
Optic Trocar
Ancillary Trocars
TERMINATION OF THE LAPAROSCOPIC PROCEDURE
COMPLICATIONS IN PORT PLACEMENT
Type 1 Injuries
Type 2 Injuries
Vascular and Visceral Lesions at Port Placement
Visceral Lesions
False Route of the Gas
Early Complications
Vascular Lesions
Bowel Lesions
Bladder and Ureter Injuries
Late Complications
FUTURE PERSPECTIVE
ACKNOWLEDGMENTS
SECTION 2: THE LEARNING CURVE
CHAPTER 4:
Gray's Anatomy of Female Pelvis as Seen through the Laparoscope
INTRODUCTION
PELVIS BOUNDARIES
ORGANS IN THE PELVIS
LIGAMENTS/SUPPORTS OF THE UTERUS
BONES AND MUSCLES
VASCULAR ANATOMY
Important Aspects of Inferior Epigastric Artery and Vein
Arteries
Internal Iliac Artery
Uterine Artery
Superior Vesicle Artery
Obliterated Hypogastric Artery
Obturator Artery
Inferior Epigastric Artery
Veins
Common Iliac Vein
Internal Iliac Vein
External Iliac Vein
Uterine Vein
THE SPACES
Pouch of Douglas or the Rectovaginal Space
Pararectal Space
Paravesical Space
Prevesical Space
URETERIC ANATOMY
Blood Supply
NERVES
Genitofemoral Nerve
Obturator Nerve
Hypogastric Nerve
Pelvic Splanchnic Nerve
Lymphatics
Ten Commandments/“Mantras”
CHAPTER 5:
Principle and Use of Electrosurgery in Laparoscopy
INTRODUCTION
HISTORY
NOMENCLATURE
BIOPHYSICAL PRINCIPLES
ELECTROSURGERY: MONOPOLAR OR BIPOLAR MODALITY
TISSUE EFFECTS
Cutting Current
Coagulation Current
Blended Current
BIPOLAR INSTRUMENTS
CURRENT USES OF ELECTROSURGERY IN MINIMALLY INVASIVE PROCEDURES IN GYNECOLOGY
UNDESIRABLE EFFECTS OR ACCIDENTS AND ITS PREVENTION
CHAPTER 6:
Laparoscopic Suturing
INTRODUCTION
METHODOLOGY
EQUIPMENT
Needle Holder
Practical Hints
Jaw
Shaft
Handle
Needles
Passage of Needle
Suture Material
Introduction of a Suture in the Peritoneal Cavity
Transferring a Suture Ligature into the Peritoneal Cavity through a Cannula
KNOTS
Types of Knots
SUTURING TECHNIQUE
Loop Ligatures
Use of Slipping Endoloops
Technique of Inserting Slipping Endoloops
Intracorporeal
Extracorporeal
Roeder's Knot
Auotomated Systems
Robotics
EROGONOMICS AND PORT PLACEMENT
SUTURING IN A VERTICAL ZONE
CHAPTER 7:
Tissue Retrieval
INTRODUCTION
TISSUE RETRIEVAL THROUGH 5 MM PORT
REPLACING 5 MM PORT BY 10 MM PORT
ENDOBAGS FOR TISSUE RETRIEVAL
MORCELLATION FOR TISSUE EXTRACTION
ENDOSCOPIC KNIFE FOR TISSUE MORCELLATION
COLPOTOMY
ACKNOWLEDGMENTS
CHAPTER 8:
Anesthesia in Laparoscopy
INTRODUCTION
TROCAR INSERTION
INSUFFLATION
CHANGES DUE TO CARBON DIOXIDE (CO2)
Various Complications due to CO2
CO2 Embolism
VENTILATORY AND RESPIRATORY CHANGES AND COMPLICATIONS4,5
Causes of Increased PaCO24
PNEUMOTHORAX, PNEUMOMEDIASTINUM AND PNEUMOPERICARDIUM4
HEMODYNAMIC AND CARDIOVASCULAR CHANGES AND COMPLICATIONS
OTHER SYSTEMIC CHANGES
Acid Aspiration
Renal Function
Intracranial Pressure and Intraocular Pressure
Thromboembolism
Temperature Variations
Neurohumoral Stress Response
Positioning of the Patient
ANESTHETIC MANAGEMENT
Preoperative or Preanesthetic Assessment
Preoperative Investigations
Preoperative Preparation
Premedication
Intraoperative Management
Monitoring
Choice of Anesthesia Technique
Regional Anesthesia
General Anesthesia
Postoperative Analgesia
Postoperative Nausea and Vomiting
Combined Regional and General Anesthesia
Local Anesthesia
SECTION 3: LAPAROSCOPY
CHAPTER 9:
Diagnosis and Treatment of Ectopic Pregnancy
INTRODUCTION
THE IMPLANTATION WINDOW
DIAGNOSTICS—PRETREATMENT ASSESSMENT OF ECTOPIC PREGNANCIES
Serum Level of β-hCG
Imaging Signs in Ultrasound Scan
Progesterone Levels
DIFFERENTIAL DIAGNOSIS
TREATMENT OF ECTOPIC PREGNANCIES
Expectant Treatment
Medical Treatment
Surgical Treatment General Beginning
Diagnostic Laparoscopy—Evacuation of the Hemoperitoneum—followed by Operative Laparoscopic Treatment in the Same Session
Surgical Treatment of Tubal Pregnancy
Salpingostomy
Evacuation by Aquadissection or Aspiration, Luxation and Preparation
Partial Salpingectomy
Salpingectomy
Surgical Technique for Nontubal Ectopic Pregnancy
Ovarian Pregnancy
Abdominal Pregnancy
Interstitial or Cornual Pregnancy/Rudimental Uterine Horn
Cesarean Scar Ectopic Pregnancy
Intraligamental Gravidity
Cervical and Vaginal Pregnancy
Simultaneous Intra-and Extrauterine Pregnancy
COMPLICATIONS
ACKNOWLEDGMENTS
CHAPTER 10:
Laparoscopic Hysterectomy
INTRODUCTION
INDICATIONS
INFORMED CONSENT
PREOPERATIVE MANAGEMENT
POSITIONING AND PREPARATION
TROCAR PLACEMENT
PROCEDURE
POSTOPERATIVE MANAGEMENT
FOLLOW-UP
CHAPTER 11:
Laparoscopic Myomectomy
INTRODUCTION
PREOPERATIVE CONSIDERATIONS
INTRAOPERATIVE CONSIDERATIONS
Pedunculated Fibroids/Small Defects
POSTOPERATIVE CONSIDERATIONS
CHAPTER 12:
Adenomyosis—Management and Laparoscopic Surgery
INTRODUCTION
RECENT GUIDELINES AND MANAGEMENT
FERTILITY SPARING LAPAROSCOPIC SURGERY IN ADENOMYOSIS
Classification of Uterine-sparing Surgery
Currently Available Methods of Uterine-sparing Surgical Treatment
Complete Excision of Adenomyosis/Adenomyomectomy
Cytoreductive Surgery/Partial Adenomyomectomy
Laparoscopically-assisted Vaginal Excision
Non-excisional Techniques
Results after Uterine-sparing Surgical Treatment for Adenomyosis
Pregnancy-related Issues and Potential Complications
Laparotomy or Laparoscopy
CONCLUSION
CHAPTER 13:
Laparoscopic Management of Endometriosis
INTRODUCTION
PATHOGENESIS
DIAGNOSIS
Delay of Diagnosis
PERITONEAL AND OVARIAN ENDOMETRIOSIS
Peritoneal Endometriosis
Minimal and Mild Endometriosis
Ovarian Endometrioma
Ovarian Endometrioma and Surgery
Place of Transvaginal Laparoscopy
CONCLUSION
CHAPTER 14:
Laparoscopic Colposuspension
INTRODUCTION
INDICATION
PREOPERATIVE TREATMENT
Preparation in the Theater
Procedure
Step One
Step Two
Step Three
Step Four
POSTOPERATIVE TREATMENT
SECTION 4: SPECIAL SITUATIONS FOR MINIMALLY INVASIVE APPROACH
CHAPTER 15:
Laparoscopic Subtotal Hysterectomy
GENERAL INTRODUCTION
ETIOLOGY
THE GENETICS OF FIBROIDS, GENOTYPE AND PHENOTYPE
MICROSCOPIC FACTS AND FIBROID VIABILITY
COSTS OF FIBROIDS
WILL THE OVARIES BE REMOVED OR LEFT IN PLACE?
RESECTION OF FALLOPIAN TUBES IN CASES OF HYSTERECTOMY
TOTAL VERSUS SUBTOTAL (SUPRACERVICAL) HYSTERECTOMY
Operative Technique
General Aspects
Preoperative Preparation
Instruments and Equipment
Prerequisites
Steps of Surgery
Port Placement
Optic Trocar
Ancillary Trocars
COMPARISON TO LTH
General Aspects
Preoperative Preparation
Instruments and Equipment
Steps for Surgery
Posthysterectomy Inspection
Postoperative Management
Anticipated Problems
Postoperative Management
Anticipated Problems
SUMMARY AND CONCLUSION
CHAPTER 16:
Laparoscopy in Pregnancy
INTRODUCTION
PHYSIOLOGIC CHANGES IN PREGNANCY
DIAGNOSIS AND WORKUP
Ultrasound
X-ray
CT Scan
Magnetic Resonance Imaging
Nuclear Medicine
Cholangiography
Endoscopic Retrograde Cholangiopancreatography
PATIENT SELECTION
ANESTHESIA
PATIENT POSITIONING
INITIAL PORT PLACEMENT
INSUFFLATION PRESSURE
VENOUS THROMBOEMBOLIC PROPHYLAXIS
HEMOSTATIC TECHNIQUES
ADNEXAL MASSES
Adnexal Torsion
CERVICAL INCOMPETENCE
HETEROTOPIC PREGNANCY
APPENDICITIS
GALLBLADDER DISEASE
SOLID ORGAN RESECTION
PERIOPERATIVE CARE
CONCLUSION
CHAPTER 17:
Non-Descent Vaginal Hysterectomy
NATURAL ORIFICE HYSTERECTOMY
INDICATIONS
CONTRAINDICATIONS
CAUTION
ANESTHESIA
POSITION
INSTRUMENTS
SUTURES
METHOD
POSTOPERATIVE CARE
ADVANTAGES
SPECIAL CASES
Previous Cesarean Section
Fibroids
Adenomyoma
Endometriosis
Adnexal Masses
Slipped Ligature
COMPLICATIONS
SECTION 5: COMPLICATIONS
CHAPTER 18:
Diagnosis and Management of Laparoscopic Complications
COMPLICATIONS
Intraoperative
Vascular Complications
Urological Injuries
Bladder Injuries
Ureteroneocystostomy
CHAPTER 19:
Medicolegal Cases
CASE NO. 1
Re: Question No. (i) and (ii)
Re: Question No. (iii)
Re: Question Nos. (iv) and (v):
Re: Question No. (vi):
CASE NO. 2
CASE NO. 3
CASE NO. 4
CASE NO. 5
CASE NO. 6
CASE NO. 7
SECTION 6: HYSTEROSCOPY
CHAPTER 20:
Instrumentation in Hysteroscopy
INTRODUCTION
ROOM SETUP
SYSTEMS USED FOR THE FLOW RATE AND IRRIGATION PRESSURE
COLD LIGHT SOURCE
IMAGING SYSTEM
TELESCOPES
OFFICE HYSTEROSCOPY
MECHANICAL INSTRUMENTS
ELECTRICAL INSTRUMENTS
HIGH FREQUENCY ELECTROSURGICAL UNITS
ADVANTAGES OF BIPOLAR ENERGIES OVER MONOPOLAR
MAINTENANCE AND STERILIZATION OF INSTRUMENTS
FUTURE OF HYSTEROSCOPIC INSTRUMENTATION
CHAPTER 21:
Hysteroscopic Septum Resection
INTRODUCTION
EMBRYOLOGICAL ANTECEDENTS OF THE SEPTUM
SPECTRUM OF REABSORPTION FAILURE
ROLE OF THE SEPTUM IN INFERTILITY AND REPEATED PREGNANCY LOSSES AND INDICATIONS FOR TREATMENT
CLINICAL PRESENTATION
CLINICAL EXAMINATION
DIAGNOSTIC MODALITIES
Hysterosalpingography
2D Ultrasound
3D Ultrasound
MRI
Diagnostic Hysteroscopy with Laparoscopy
PREOPERATIVE EVALUATION
HYSTEROSCOPIC RESECTION OR METROPLASTY
Resection Methods Employing Electrolyte Distending Media
Hysteroscopic Scissors
VersapointTM
Bipolar Needle Electrode and Laser
Bipolar Resectoscope
Resection Methods Employing Nonelectrolyte Distending Media
Monopolar Needle Electrode
Resectoscope
CERVICAL SEPTUM
VAGINAL SEPTUM
POSTOPERATIVE MANAGEMENT
COMPLICATIONS
SURGICAL RESULTS AND GUIDELINES
CONCLUSION
CHAPTER 22:
Office Hysteroscopy
INTRODUCTION
DEFINITION
INDICATIONS
TECHNIQUE
Vaginoscopy
Operative Procedures
CONTRAINDICATIONS
SUCCESS RATES
ADVANTAGES
CHAPTER 23:
Hysteroscopic Cannulation of Proximal Tubal Block
INTRODUCTION
ANATOMY OF PROXIMAL TUBE
PATHOLOGY
CLASSIFICATION OF PROXIMAL TUBAL OCCLUSION
MECHANISM OF RESTORING FERTILITY
SURGICAL METHODS OF REMOVAL OF PROXIMAL TUBAL OCCLUSION
Advantages of Hysteroscopic and Laparoscopic-guided Tubal Cannulation
Instruments
Procedure
Complications
Contraindications
CONCLUSION
CHAPTER 24:
Hysteroscopic Myomectomy
INTRODUCTION
SUBMUCOUS FIBROIDS
DIAGNOSIS OF LEIOMYOMAS
INVESTIGATIONS FOR UTERINE FIBROIDS
Hysterosalpingography
Ultrasonography
Contrast Hysterosonography
Three-Dimensional Ultrasound
CT Scan
Magnetic Resonance Imaging
Hysteroscopy
CONTRAINDICATIONS TO HYSTEROSCOPIC MYOMECTOMY
PREOPERATIVE INVESTIGATIONS
Hematological and Cytological Investigations
PREOPERATIVE PREPARATION
Preoperative Clinical Evaluation
Antibiotic Prophylaxis
Difficult Cervical Dilatation or Cervical Stenosis
Endometrial Preparation
Diagnostic Hysteroscopy
Operative Office Hysteroscopy
SURGICAL PROCEDURES
General Principles
Submucosal Fibroids
Fibroids with an Intramural Component
HYSTEROSCOPIC MORCELLATION
Hysteroscopic Morcellation Technique
HYSTEROSCOPIC RESECTION OF INTRAMURAL MYOMAS
POSTOPERATIVE ADHESION PREVENTION
COMPLICATIONS
Mechanical Complications
Media-related Complications
Bleeding
Infection
TRAINING IN HYSTEROSCOPIC MYOMECTOMY
CONCLUSION
CHAPTER 25:
Complications in Hysteroscopic Surgery—Prevention and Management
INTRODUCTION
PREOPERATIVE PRECAUTIONS
CLASSIFICATION OF COMPLICATIONS
ENTRY-RELATED MECHANICAL CAUSES
Entry-related Trauma and Perforation
Cervical Laceration
Entry-related Perforations
Failed Entry (Flow chart 1)
Acute Flexion Problems
Cervical Stenosis
METHOD-RELATED COMPLICATIONS
Technique-Related Complications
Perforations (Figs 1 and 2)
Intraoperative Hemorrhage
Media-related Complications
VASOVAGAL REACTION/SYNCOPE
GAS EMBOLISM
Management: Standard Protocol
ELECTROSURGICAL COMPLICATIONS
POSTOPERATIVE AND LATE COMPLICATIONS
Infection
Endometrial Cancer
Iatrogenic Adenomyosis
Hematometra
Postendometrial Ablation Tubal Ligation Syndrome
Prevention
Treatment
Pregnancy-related Issues
CONCLUSION
INDEX
TOC
Index
×
Chapter Notes
Save
Clear