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Gynaecological laproscopy
- 1. Gynaecological Laproscopy Dr. Shweta Ginoya 29.06.2012
- 2. • Laparoscopy literallymeans, "to look inside the abdomen".
- 3. • Laparoscopy isa surgical procedure that involves insertion of a narrow telescope-like instrument through a small incision in the belly button. • This allows visualization of the abdominal and pelvic organs.
- 4. Indications • Diagnostic Laparoscopy: 1.Infertilitywork up-Ovulation study -Tubal patency -Endometriosis - Pelvic adhesions 2.Acute pelvic lesion-Acute ectopic -Acute Appendicitis -Acute Salpingitis
- 5. 3.Pelvic mass-Fibroid -Ovarian Cyst 4.Follow up of pelvic surgery -Tuboplasty -Ovarian malignancy -Evaluation of endometriosis Rx 5.Suspected Mullerian abnormalitis 6.Suspected Uterine perforation 7.To take biopsy
- 6. • Therapeutic Laparoscopy -Adhesiolysis -Aspirationof ovarian cyst -Ovarian drilling -Ovarian cystectomy -Ectopic pregnancy -Tubal sterilization -Endometriosis(Laser or thermal ablation) -Myomectomy -LAVH
- 7. Contraindications • Severe cardiopulmonary diseases • Generalised peritonitis • Intestinal obstruction • Significant hemoperitoneum • Extensive peritoneal adhesions • Large pelvic tumour • Obesity • Pregnancy >16 wks
- 8. COMPLICATIONS OF LAPAROSCOPIC SURGERIES 1. AnaestheticComplications 2. Complications due to pneumoperitonium 3. Surgical complications 4. Diathermy related injuries 5. Patients factors related complications 6. Post operative complications
- 9. SURGICAL COMPLICATIONS • Injury to Viscus : • Stomach -Hyperventilation by Mask Distended stomach Injured with trochar or needle • Diagnosis - • Laparoscopic view of inside of stomach
- 10. • Management – • Extend trocar incision into a minilap. for a two layer closure. • Laparosocpically - Pursestring suture or a figure of 8 suture in the seromuscular layer surround the defect. - Nasogastric tube drainage for two days.
- 11. • Bowel- May be injured due to trocar or veress needle. Diagnosis - • Foul smelling gas through pneumo-peritoneal needle is a helpful diagnostic sign. • There may be GI contents at the tip of needle. Management – • If due to verres’ needle it is managed conservatively. • Mini laprotomy and repair of perforation. • It may be sutured of laparoscopic stapler (ENDO-GIA) can be used. • Colostomy.
- 12. • Small BowelPerforation - Most often during insertion of umblical or lower quadrant trocars . • Usually recognized later in the procedure • If adhesions are not freed from anterior abdominal wall perforation may not be recognized
- 13. • Management – •One should consider higher primary site if adhesions are found through umblical port. • Perforation repaired transversally • If injury is free of adhesions bowel can be withdrawn through 10 mm trocar tract and repaired
- 14. • Injury toViscus : • Bladder - Injury caused by second puncture trocar usually . • Diagnosis : Appearance of gas and blood in Foley’s catheter bag. • Management – • Early detection is important. • Place an indwelling catheter for 7-10 days and prophylactic antibiotics - If defect is larger. • Repaired by a figure of 8 suture through muscularis of bladder & second suture to close peritonium.
- 15. • Ureter -May be injured in adenexal surgeries. • Thermal injury will result in ureteral narrowing and hydroureter. Management – • Placement of ureteric stent for 3 – 6 weeks
- 16. Vessel Injury: • Largervessels may be injured by trocar or verres’ needle. • CO2 peritoneum may tamponade a large vessel injury. When pressure normalizes it starts bleeding. • Management – • Examine the course of large vessels. • Overlying peritoneum is opened with laproscopic scissors or a CO2 laser. • Hematoma evacuated by alternate suction and irrigation. • *Laprotomy is required if hematoma is expanding or persistent bleeding.
- 17. Epigastric Vessels – •Deep epigastric vessels most frequently injured in laproscopic hysterectomy. • Management – • By Tamponade – • Rotate second puncture sleave by 3600. • By Foley’s catheter • Bipolar coutery • Needle suturing • Small haemostate (Mosquito clamp)
- 18. Ovarian or uterinevessels – • Injured during laproscopic hysterectomy • Management – • Bipolar desiccation • Ureter must be identified before desiccation
- 19. DIATHERMY RELATED INJURIES Dueto – • Inadvertent activation of the diathermy pedal. • Faulty insulation • Direct coupling Injuries – • Thermal necrosis of organs. • Inadvertent organ ligation. • Unrecognized haemorrhage.
- 21. PATIENT’S FACTORS RELATED COMPLICATIONS • Obesity • Ascites • Organomegaly – organ damage • Coagulation disorder – haemorrhage
- 22. POST OPERATIVE COMPLICATIONS • Concealed injury to organs • Delayed fecal fistula • Port site metastasis • Recidual air (Referred chest or shoulder pain)
- 23.