Dr. Dubuisson stated that there is is a great demand from patients for minimally invasive surgery and it is important that the surgeon apply certain conditions to the selection of patients for successful treatment of leiomyomas by laparoscopy. Dr. Dubuisson said that the indications for a safe laparoscopic myomectomy include the following:
Laparoscopic hysterectomy is indeed promising, but it is not yet within the capability of most gynecologists. Further refinement in the technique is needed before it is ready for general endorsement.
When performing operative laparoscopy and using bipolar current to achieve hemostasis or desiccate vessels, there are a couple of simple techniques that can make the task easier for the surgeon. The first trick alleviates the frustration when one is attempting to desiccate either vessels or tissue with a bipolar instrument, and the instrument keeps sticking to the tissue and the char. Inevitably then when the surgeon attempts to remove the instrument or pull it from contact with the tissue, the seal is broken and the vessel or tissue begins bleeding again.
Mackendrodt performed the first colonic resection for sigmoid endometriosis in 1909. Research has revealed that approximately 10 percent of menstruating women have endometriosis and up to 34 percent may have intestinal involvement.
Laparoscopy has been steadily replacing laparotomy because the abdomen does not have to be opened up, resulting in faster recovery and reduction of complications. In laparoscopy, only three small incisions are made for the entry of a small camera and other instruments. Thus, the operation that is taking place inside the abdomen/pelvis can be viewed on a video screen placed next to the operating table.
The word Laparoscopy simply means visual examination of the abdomen by means of a laparoscope. Laparoscopy (often called "belly button surgery", endoscopy, or key hole surgery) is a surgical technique involving small incisions in the abdomen through which major surgical procedures can be performed. One of the incisions is made in the umbilicus ("belly button").
For pelvic floor repair we use the following principles.1. Site specific repair i.e. repair of the defect only. 2. Restrictive use of a mesh i.e. when necessary only. A mesh by definition carries a little risk of complications such as infection, of mesh erosion and more complicated subsequent surgery when necessary. 3. The use of a mesh when the vaginal wall is opened should be avoided.
Laparoscopy is now an option for many gynecological conditions. This overview discusses specific laparoscopic procedures and the conditions they treat.
Whenever the surgery that is considered can be performed equally well and equally safely by either laparoscopy or laparotomy, the decision as to the type of incision to be used can (and in my opinion really should) include the patient.
The goal of laparoscopic repair of female organ prolapse is to restore normal functioning by correcting female organ supporting defects in the pelvis. The supporting system in the female pelvis is quite complex; however, it is dynamic rather than static. There are basically two systems in the pelvis that provides the active and passive support of pelvic organs to their proper places.
A significant number of women experience infertility due to surgically correctable causes. Most cases are a result of endometriosis and/or adhesions (scar tissue) from previous surgery or pelvic infection. Endometriosis and adhesions cause distortion and blockage of the fallopian tubes, thus causing infertility. Infertility surgery tries to unblock, release and restore normal anatomy of the fallopian tube.
What could be easier? You arrive in the morning, have your procedure then leave later the same day. This is called out patient surgery. One of the most common and preferred choices of both physicians and patients. This is made possible by less invasive techniques that still facilitate the same, if not better surgery. Everything from anesthesia to recovery is taken care of in a matter of hours. Preparing for such a surgery goes beyond reading the pamphlets your physician hands you. Do your homework and ask questions! The success of both your procedure and recovery depends on YOU.
Laparoscopic hysterectomy (LH) is an optimum approach to the second most common surgical procedure in the United States. There are close to 600,000 hysterectomies performed annually in the US, with the majority performed via the abdominal route.
Video of Laparoscopic Hysterectomy
Because endometriosis is a common disease entity among infertile patients with a prevalence of up to 50%, one could argue that without laparoscopy clinical work-ups can not completely rule out all of the causes of infertility. The decision to perform laparoscopy on patients with infertility is very complex owing to a number of factors, such as maternal age, semen parameters, tubal patency, pelvic symptoms, insurance coverage, surgical risks, and availability of surgical expertise.
Endometriosis is one of the most common gynecologic disorders and is significantly more prevalent in the setting of infertility. The prevalence of endometriosis in infertile women ranges from 25% to 50% compared to 5% in fertile women. Successful laparoscopic management of all stages of endometriosis was reported as early as 1986. This has revolutionized the management of endometriosis. The benefits of surgical therapy for infertility associated with endometriosis have been well documented.
It is advantageous to perform surgery in the least invasive way possible while still getting optimal results. Although I usually prefer to do surgery through a laparoscope rather than through a larger incision, I have felt limited by the lack of wrist-like movements of the instruments. I felt that deeper myomas (that couldn’t be removed by a hysteroscope) were better removed through a regular incision.
Excess absorption of liquid distending media is one of the most frequent complications of operative hysteroscopy. Although most women recover uneventfully, we are seeing cases of permanent morbidity or death resulting from this complications.
Currently there are two ways to treat endometriosis – hormonal therapy and surgery. Depending on the patient’s expectations and the extent of the disease, we may prescribe hormonal therapy, surgery, a combination of surgery and hormonal therapy, or occasionally a just “wait and see” approach.
Fibroids are non-cancerous (benign) growths of the muscle wall of the uterus. They are probably responsible for more unnecessary gynecologic surgery than any other condition. Every year a staggering 600,000 American women have a hysterectomy. And about 30 percent of those hysterectomies, 180,000 in all, are performed because of fibroids. For many years gynecologists have surgically removed these growths, often because of fear of the problems they might cause in the future. And those problems are often overstated.
Approximately 750,000 hysterectomies are performed annually in the United States, with a mortality rate of about 12 per 10,000 operations.1 Costs to consumers and insurers have been estimated at approximately $1.7 billion per year.2 Thus, alternative procedures that are safer and less invasive, preserve the uterus, and cost less are increasingly in demand. In recent years, several such techniques have been introduced.
Laparoscopic myomectomy (LM) is a minimally invasive surgical procedure for the removal of uterine myomas. It was first described in the late 1970s by Semm. Subsequently, equipment has been developed to enhance the procedure. LM requires advanced laparoscopic skill and expertise in suturing and tissue removal. Laparoscopic assisted myomectomy (LAM), a procedure that combines operative laparoscopy and minilaparotomy, was described by Nezhat et al in 1994.
Rectovaginal fistula (RVF) is an epithelium-lined communication between the rectum and vagina. Most RVFs are acquired, the most common cause being obstetric trauma. Most of the high RVFs are repaired by conventional open surgery. Laparoscopic repair of RVF is rare and so far only one report is available in the literature.
A Randomised Controlled Trial to Assess the Efficacy of Laparoscopic Uterosacral Nerve Ablation (LUNA) in the Treatment of Chronic Pelvic Pain: The trial protocol [ISRCTN41196151]The LUNA Trial Collaboration
Fallopian tube prolapse as a complication of abdominal hysterectomy is a rare occurrence. A case with fallopian tube prolapse was managed by a combined vaginal and laparoscopic approach and description of the operative technique is presented.
