Reproduction System- Laparoscopy and Hysteroscopy by Lao

Reproduction System- Laparoscopy and Hysteroscopy by Lao

Indications:
Sterilization
Evaluation for Chronic pelvic pain and endometriosis
Hysterectomy
Ectopic pregnancy
Expanding with minimally invasive surgery*

internal iliac artery supplies the uterus.

Contraindications:
Intestinal obstruction
Hemodynamic instability
Morbid obesity???
Extensive intra-abdominal scarring

uses open dissection and Hassan trocar (reusable)

uses veres needle and optical ports
Entry pressure <8 mmHg
Max pressure <14-16 mmHg

rectus abdominus, external/internal oblique, transversus abdominus

umbilicus. good entry point. thinnest and easiest place to gain entry into the peritoneal cavity

CO2 Gas to achieve pneumoperitoneum

Nitric Oxide: Pain mapping (awake)
Avoids build up of carbonic acid

Pushing minimally invasive surgery to limits
Costly $$$$$$$
Time consuming due to docking time
Role for converting open hysterectomy to laparoscopic

Single Incision:
Least invasive
Recent robotic hysterectomy
Requires reticulating instruments and flexible scope
Steep learning curve

Direct visualization of the endometrial cavity using and endoscope and light source.

-Repetitive abnormal uterine bleeding
-Recurrent pregnancy loss
-Uterine synechiae
-Removal of IUD
-Ablation of the endometrium
-Sterilization
-Polypectomy or myomectomy
-Incision of uterine septum

Contraindications include:
-Unfamiliarity with equipment, instruments, or technique
-Lack of appropriate equipment or staff familiar with the equipment
-Acute pelvic inflammatory disease
-Pregnancy & Genital tract malignancies
-Lack of informed consent
-Inability to dilate the cervix
-Inability to distend the uterus to obtain visualization
-Poor surgical candidates who may not tolerate fluid overload because of renal disease, or radiofrequency current when a cardiac pacemaker is present
-The patient desires and expects complete amenorrhea

**Fluid overload (the biggest issue)-> treat with lasix
Electrolyte disturbances
Infection
Bleeding
Asherman’s syndrome
Perforation

Hysteroscopic sterilization
As effective as post-partum sterilization
Can be done in the office
Requires 3 months back up contraception (one of the only downside)
FDA requires 3 month post op HSG to confirm tubal blockage