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Comprehensive Video Atlas of Laparoscopic Surgery in Infertility and Gynecology
by Nutan JainIn this video case of 38-years-old female patient, present complaints severe pain during menses and menorrhagia.Presumptive diagnosis: Bilateral endometriotic cyst with adenomyosis uterus. Port placement: Patient laid in modified lithotomy position under GA. Four ports laparoscopy done, all the ports are 5 mm except camera port which is 10 mm. Surgical procedure: Firstly, a 5 mm port is inserted through the Jain point about one finger above the left paraumbilical point. The patient was young and wanted to conserve ovaries. First, we started clearing the pouch of Douglas and bilateral densely adherent ovaries. Ovaries are stuck to the back surface of uterus, bilateral uterosacral ligaments and ovarian fossa. Antegrade blunt and sharp dissection was done and ovaries cleared from pouch of Douglas. Ureter identified lateral to the sacral promontory at the pelvic brim. Peritoneum opened up and ureteric dissection continued till the uterosacral ligament. Bilateral pararectal spaces identified with lateral mobilization of ureters. Both nodular uterosacral ligament excised. Rectum mobilization done with rectal probe in situ. The pouch of Douglas and rectovaginal space totally cleared. TLH done using vessel sealer and both ovaries conserved. Both vaginal angle sutured separately by taking the bite through uterosacral ligament. Right and left handed KOH needle holders applied in ipsilateral suturing for the vaginal vault closure. Both side cyst wall enucleation done after injecting diluted vasopressin. Injecting vasopressin facilitates the plane between ovarian cortex and cyst wall.
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