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Transvaginal laparoscopy: subtle lesions and infertility
Transvaginal laparoscopy is performed as a simple needle puncture technique of the pouch of Douglas in patients without an obvious pelvic pathology. An obliterated pouch of Douglas and acute situations such as bleeding and infections are contraindications. As a distension medium, a watery solution such as Ringer lactate is used. This keeps organs afloat. Without extra manipulation, ovaries and tubes can be inspected in their natural position. In absence of a high intra-abdominal pressure as in standard laparoscopy, subtle lesions are not masked but become clearly visible due to the watery distension medium. The transvaginal approach also provides easy access to perform a salpingoscopy and allows the detection of subtle tubal mucosal lesions. The technique allows early detection of peritoneal and ovarian endometriosis with the possibility of early treatment.
S Gordts
Lecture
5 years ago
810 views
27 likes
0 comments
23:35
Transvaginal laparoscopy: subtle lesions and infertility
Transvaginal laparoscopy is performed as a simple needle puncture technique of the pouch of Douglas in patients without an obvious pelvic pathology. An obliterated pouch of Douglas and acute situations such as bleeding and infections are contraindications. As a distension medium, a watery solution such as Ringer lactate is used. This keeps organs afloat. Without extra manipulation, ovaries and tubes can be inspected in their natural position. In absence of a high intra-abdominal pressure as in standard laparoscopy, subtle lesions are not masked but become clearly visible due to the watery distension medium. The transvaginal approach also provides easy access to perform a salpingoscopy and allows the detection of subtle tubal mucosal lesions. The technique allows early detection of peritoneal and ovarian endometriosis with the possibility of early treatment.
How to improve exposure in laparoscopy: organ suspension with the T-Lift™ device
Organ suspension using a T-lift™ device is a simple method to enhance exposure in laparoscopic surgery, providing adequate vision and operating space and allowing the assistant to focus on helping the surgeon, thus reducing operative times, without the need for difficult intra-abdominal needle manipulation as well as the risk of bowel and vascular injury associated with that approach.
Several examples of organ suspension with the T-lift™ are demonstrated in this video, including suspension of the ovaries, sigmoid colon or vagina in simple procedures, as well as in more complex procedures, for instance by holding the anterior rectal wall for bowel resection with transanal specimen extraction.
A Wattiez, J Albornoz, E Faller, M Puga
Surgical intervention
6 years ago
7999 views
468 likes
0 comments
07:12
How to improve exposure in laparoscopy: organ suspension with the T-Lift™ device
Organ suspension using a T-lift™ device is a simple method to enhance exposure in laparoscopic surgery, providing adequate vision and operating space and allowing the assistant to focus on helping the surgeon, thus reducing operative times, without the need for difficult intra-abdominal needle manipulation as well as the risk of bowel and vascular injury associated with that approach.
Several examples of organ suspension with the T-lift™ are demonstrated in this video, including suspension of the ovaries, sigmoid colon or vagina in simple procedures, as well as in more complex procedures, for instance by holding the anterior rectal wall for bowel resection with transanal specimen extraction.
Fertility enhancing surgery
Professor David Adamson focuses on the role of laparoscopy in subfertile patients. Laparoscopy helps to diagnose and manage many gynecologic conditions that may induce spontaneous pregnancy and enhance Assisted Reproductive Technology (ART) results. In endometriosis, laparoscopy is required to establish the diagnosis and provide a better vision: it is first recommended in stage I-II by the American Society for Reproductive Medicine (ASRM). It should be considered in stage III-IV if the patient is young and after several IVF failures. Laparoscopic cystectomy is suitable if endometrioma is larger than 4cm prior to IVF. Myomas have to be removed when they distort the cavity or when they are intramural and voluminous. Laparoscopic myomectomy must be carried out by skilled surgeons. Adnexal masses should be removed if they exceed 5cm and persist for more than 3 months. Concerning polycystic ovarian syndrome (PCOS), ovarian drilling is indicated in case of failure of controlled ovarian hyperstimulation (COH). Laparoscopy is very useful for distal tubal occlusion to assess the quality of the tube and perform fimbrioplasty. It is also useful for ectopic pregnancy and sterilization reversal. As a conclusion, laparoscopy in subfertile patients must be performed in young women, without other infertility factors. Laparoscopy should also be envisaged when the disease is treatable and when the patients agree to have a 9 to 15 months’ interval prior to IVF.
D Adamson
Lecture
7 years ago
2412 views
16 likes
0 comments
26:49
Fertility enhancing surgery
Professor David Adamson focuses on the role of laparoscopy in subfertile patients. Laparoscopy helps to diagnose and manage many gynecologic conditions that may induce spontaneous pregnancy and enhance Assisted Reproductive Technology (ART) results. In endometriosis, laparoscopy is required to establish the diagnosis and provide a better vision: it is first recommended in stage I-II by the American Society for Reproductive Medicine (ASRM). It should be considered in stage III-IV if the patient is young and after several IVF failures. Laparoscopic cystectomy is suitable if endometrioma is larger than 4cm prior to IVF. Myomas have to be removed when they distort the cavity or when they are intramural and voluminous. Laparoscopic myomectomy must be carried out by skilled surgeons. Adnexal masses should be removed if they exceed 5cm and persist for more than 3 months. Concerning polycystic ovarian syndrome (PCOS), ovarian drilling is indicated in case of failure of controlled ovarian hyperstimulation (COH). Laparoscopy is very useful for distal tubal occlusion to assess the quality of the tube and perform fimbrioplasty. It is also useful for ectopic pregnancy and sterilization reversal. As a conclusion, laparoscopy in subfertile patients must be performed in young women, without other infertility factors. Laparoscopy should also be envisaged when the disease is treatable and when the patients agree to have a 9 to 15 months’ interval prior to IVF.
Fertility enhancing surgery
Reproductive surgery does not solely include tubal surgery, but also uterine surgery (surgery for malformations and myomas) and treatment for endometriosis. In tubal surgery, distal lesions can either be classified as phimosis (partial obstruction) or hydrosalpinx (complete obstruction). Phimosis requires fimbrioplasty; hydrosalpinx needs a neosalpingostomy. Proximal lesions may be functional (spasm, mucosal plugs) or organic (tubal clips, SIN, PID) which need resection and anastomosis. Tubal surgery does not rival with IVF but it is a complementary tool that may be used in selected cases.

To achieve adequate selection of cases suitable for tubal surgery, it is mandatory to accurately evaluate the uterine cavity, the tubal patency, the tubo-peritoneal environment (adhesions) as well as the tubal mucosa.
Non-invasive tests (hysterosalpingography, hysterosonography) do not permit to give a precise analysis of the lesions. Endoscopy is the only way to solve this problem. Fertiloscopy allows an exploration of the pelvis and salpingoscopy allows for an adequate and simple evaluation of the mucosal tube (easier than laparoscopy).

In case of normal salpingoscopy with abnormal fertiloscopy, surgery is recommended. In other cases, the recommended treatments are intrauterine insemination (IUI) or in vitro fertilization (IVF). In case of surgery, it is necessary to apply microsurgical principles: proper magnification, sufficient light, respect of tube (no touch technique), meticulous hemostasis (bipolar), avoidance of peritoneal desiccation, acute ovaro-salpingolysis, use of microsurgical instrumentation and microsuture, prevention of adhesions. When all of these criteria are respected, good results are obtained in terms of pregnancy rate.
A Watrelot
Lecture
7 years ago
1356 views
23 likes
0 comments
22:49
Fertility enhancing surgery
Reproductive surgery does not solely include tubal surgery, but also uterine surgery (surgery for malformations and myomas) and treatment for endometriosis. In tubal surgery, distal lesions can either be classified as phimosis (partial obstruction) or hydrosalpinx (complete obstruction). Phimosis requires fimbrioplasty; hydrosalpinx needs a neosalpingostomy. Proximal lesions may be functional (spasm, mucosal plugs) or organic (tubal clips, SIN, PID) which need resection and anastomosis. Tubal surgery does not rival with IVF but it is a complementary tool that may be used in selected cases.

To achieve adequate selection of cases suitable for tubal surgery, it is mandatory to accurately evaluate the uterine cavity, the tubal patency, the tubo-peritoneal environment (adhesions) as well as the tubal mucosa.
Non-invasive tests (hysterosalpingography, hysterosonography) do not permit to give a precise analysis of the lesions. Endoscopy is the only way to solve this problem. Fertiloscopy allows an exploration of the pelvis and salpingoscopy allows for an adequate and simple evaluation of the mucosal tube (easier than laparoscopy).

In case of normal salpingoscopy with abnormal fertiloscopy, surgery is recommended. In other cases, the recommended treatments are intrauterine insemination (IUI) or in vitro fertilization (IVF). In case of surgery, it is necessary to apply microsurgical principles: proper magnification, sufficient light, respect of tube (no touch technique), meticulous hemostasis (bipolar), avoidance of peritoneal desiccation, acute ovaro-salpingolysis, use of microsurgical instrumentation and microsuture, prevention of adhesions. When all of these criteria are respected, good results are obtained in terms of pregnancy rate.
Principles of laparoscopic reproductive surgery
Professor Adamson exposes the rules for laparoscopic reproductive surgery. Laparoscopy is first part of the diagnosis, such as ultrasonography or hysterosalpingography. Preoperative principles rely on the informed and signed consent of the patient. Professor Adamson then covers intraoperative rules such as the importance of a good vizualisation (i.e., exposure), control of the surgical field, and proper use of energy sources. Prevention of adhesions is essential because the rate of adhesion is lower with laparoscopy than with laparotomy; it is however quite high (65-88%). A microsurgical technique associated with anti-adhesion barriers seems to be effective. At the end of laparoscopic surgery, the surgeon must give the patient a prognosis for fertility: the Endometriosis Fertility Index seems to be a very useful tool.
D Adamson
Lecture
7 years ago
1196 views
4 likes
0 comments
29:56
Principles of laparoscopic reproductive surgery
Professor Adamson exposes the rules for laparoscopic reproductive surgery. Laparoscopy is first part of the diagnosis, such as ultrasonography or hysterosalpingography. Preoperative principles rely on the informed and signed consent of the patient. Professor Adamson then covers intraoperative rules such as the importance of a good vizualisation (i.e., exposure), control of the surgical field, and proper use of energy sources. Prevention of adhesions is essential because the rate of adhesion is lower with laparoscopy than with laparotomy; it is however quite high (65-88%). A microsurgical technique associated with anti-adhesion barriers seems to be effective. At the end of laparoscopic surgery, the surgeon must give the patient a prognosis for fertility: the Endometriosis Fertility Index seems to be a very useful tool.
Surgical strategies and techniques for difficult hysterectomy
In gynecologic surgery, hysterectomy is the most important procedure. Sometimes, however, hysterectomy can be a very difficult and challenging operation, and even more so if performed laparoscopically. Situations that distort the pelvic anatomy such as large fibroids, severe endometriosis, postoperative adhesions and morbid obesity make surgery much more difficult. Dr Lee analyses in a very didactic way all these situations, gives valuable directions and surgical strategies in order to overcome difficulties, and uses specific rules to obtain the best result as much safely as possible. Very useful are the different approaches, namely anterior, posterior and lateral, for patients with big fibroids, for adhesions and for fibrosis originating from severe endometriosis respectively.
T Lee
Lecture
9 years ago
3119 views
51 likes
0 comments
25:34
Surgical strategies and techniques for difficult hysterectomy
In gynecologic surgery, hysterectomy is the most important procedure. Sometimes, however, hysterectomy can be a very difficult and challenging operation, and even more so if performed laparoscopically. Situations that distort the pelvic anatomy such as large fibroids, severe endometriosis, postoperative adhesions and morbid obesity make surgery much more difficult. Dr Lee analyses in a very didactic way all these situations, gives valuable directions and surgical strategies in order to overcome difficulties, and uses specific rules to obtain the best result as much safely as possible. Very useful are the different approaches, namely anterior, posterior and lateral, for patients with big fibroids, for adhesions and for fibrosis originating from severe endometriosis respectively.