Focus on gynecological surgery

In this video lecture, Dr. Mutter tells us more about bowel complications in gynecological surgery.

In this key lecture, Dr. Gharbi focuses on diagnosis and treatment for adenomyosis.

In this key lecture, Dr. Amro focuses on urinary tract endometriosis.

In this key lecture, Dr. Wattiez focuses on economical radicalism related to deep infiltrating endometriosis (DIE) treatment strategy.

In this key lecture, Dr. Ferreira focuses on the use of energies.

In this key lecture, Dr. Argay focuses on laparoscopic suturing, highlighting the theory for loading the needle and different knotting techniques.

In this key introductive lecture, Dr. Wattiez outlines laparoscopic surgical rules in gynecological surgery.

About 1 to 2% of all pregnancies are ectopic. Most ectopic pregnancies are located in the uterine tube, and surgery is often used as a treatment modality. Traditionally, salpingectomy has been the standard procedure, but salpingotomy provides a conservative option in women who wish to preserve future fertility, especially if the contralateral tube is absent or damaged. Many women do not have access to IVF for financial, geographical, or religious reasons. Having an intrauterine pregnancy after salpingotomy can reach up to 70%. In this video, we demonstrate this procedure in simple steps. The case was that of a 35-year-old lady, P0+1 with a previous right tubal pregnancy, which was treated with a partial salpingectomy through a mini-laparotomy 2 years before. She was admitted to the emergency department as she presented with a 6-week amenorrhea with left iliac fossa pain. Pelvic ultrasound showed left tubal ectopic pregnancy (4 by 3cm in size), with free fluid suggestive of hemoperitoneum. She opted for a conservative laparoscopic surgery as she was keen to have a spontaneous fertility.

This is the case of a 71-year-old woman, p2+2 with two previous cesarean sections. She had postmenopausal bleeding and she was diagnosed with simple glandular endometrial hyperplasia with focal complex atypia as demonstrated on tissue biopsy. This video demonstrates the techniques of total laparoscopic hysterectomy and bilateral salpingo-oophorectomy following standardized steps even in non-straightforward cases, i.e. previous cesarean sections, and especially with bladder dissection.

Many women who undergo tubal ligation surgery later decide to have children again. One option available to these women is tubal ligation reversal, or tubal reanastomosis. In this microsurgery, the two separated parts of a uterine tube are surgically reunited. It is ideally performed in younger women under 39 years of age with good ovarian reserve. Depending on the previously used tubal ligation method, it may be necessary to first perform a diagnostic laparoscopy to check the condition of the uterus, the uterine tubes, and the ovaries and to make sure that the tubal length is sufficient for reversal. Following the proper principles of microsurgery, this procedure can yield very good results and offer a more economical option to women desirous of childbearing if the tubal pathology related to tubal sterilization is the only cause of infertility.

Isolating the uterine artery can be performed safely and efficiently with a proper knowledge of the anatomy, as pelvic vascular anatomy is relatively constant with a very predictive retroperitoneal course. In this video, authors review the anatomy relevant to the uterine artery and demonstrate various approaches to ligating it laparoscopically. It is essential as it provides hemostasis and reduces the incidence of potential injury to bladder and ureter, particularly in cases where anatomical relationships have been distorted by intra-abdominal adhesions as in cases of previous surgery, severe endometriosis or large fibroids or when access to the cervix is limited due to wide uteri or to a fibrogenic cul-de-sac or when access to the vesicouterine space is obliterated due to previous surgeries. The various approaches to ligating the uterine artery in relation to the broad ligament are lateral, posterior, anterior, and medial. These approaches can be used based on the patient’s pathology and requirements.