1. Basic Principles in GyneLaparoscopy
DR.CHADUVULA SURESH BABU
PROFESSOR
DEPT.OF OBGYN
College of Medicine, Abha, KKU, KSA

2. INTRODUCTION
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KALK(1930) – FATHER OF INTERNAL
LAPAROSCOPY
HOPE(1937) – FIRST GYNEACOLOGICAL
REPORT ON ECTOPIC PREGNANCY
BOESCH (1936)- COAGULATION
PALMER (1943) –COLD LIGHT ENDOSCOPE.
FRANGENHEIM (1952)– CO2 INSUFFLATION
JORDEN PHILIPS – SPREAD OF LAPAROSCOPE
THROUGHOUT THE WORLD
SEMM (1970)-LAPAROSCOPIC HYSTERECTOMY

3. BASIC PREREQUISITES

GOOD KNOWLEDGE ABOUT SURGICAL
ANATOMY
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GOOD AT CONVENTIONAL SURGERIES
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REASONABLE TRAINING

GOOD EXPERIENCE

4. ANATOMY

5. LAPAROSCOPY SET UP
BASIC REQUIREMENTS:
1.TWO ASSISTANTS
2.WELL TRAINED SISTER
3.OT TECHNICIAN
4. ALL LAPAROSCOPIC INSTRUMENTS
5.TWO MONITORS
6.CO-OPERATIVE ANAESTHETIST

6. Verres Needle

7. Gas Insufflator

8. INSTRUMENTS

9. Trocar & Cannula

10. Camera

11. Laparoscope

12. Xenon Light Source

13. Uterine Elevator

14. E
quipments
Laparoscopic Tools
Video monitor

15. 1. Bipolar grasper
2. Atraumatic grasper
3. Grasping forceps
4. Toothed forceps
5. Sharp-tipped monopolar device
6. 5-10mm suction-irrigation device
7. Scissors

16. P
atient P
ositioning
Low lithotomy position
30 degree Trendelenburg
Urinary catheter
NG tube (?)
Uterine cannulation

17. T
rocar P
lacement for Surgery
A) 12mm optical trocar placed at umbilical level
B) and C) 5mm lateral operative trocars placed 3 fingerbreadths above the symphysis
pubis

18.  Peritoneum is inflated with CO2
 Needle inserted at the umbilical level (primarily used) OR at Palmer’s point (3cm
below costal margin in midclavicular line)
 Pressure should not exceed 14 mmHg- respiratory compromise

19. OT SET UP

20. INDICATIONS FOR
LAPAROSCOPY
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Diagnostic:
1] Infertility
2] Suspected Ectopic pregnancy
3] Misplaced Copper T
4] Chronic pelvic pain etc.,
Therapeutic:
1] Myomectomy
2] LAVH, TALH

21. Therapeutic Indications
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3] Ovarian Drilling in PCOD
4] Ovarian Cystectomy
5] Retrieval of misplaced copper T
6] Cauterisation of Emdometriotic spots
7] Radical Hysterectomy for cancer cervix etc.,

22. LAPAROSCOPY
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General Anesthesia
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Trendlenberg’s position
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Lights should be off
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Well trained staff
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Electrical technical assistant

24. Anatomical Review
1.
Medial tubal A.
2.
Lateral tubal A.
3.
Uterine A.
4.
Ovarian A.

25. L
aparoscopic Salpingectomy
M Risk: devascularization of the ovary
ain
 Operate close to the tube, away from ovarian vessels
and suspensory ligament

26. 1.
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Proximal tube division
Isthmus is held upwards and outwards
Isthmus is cauterized
Take care not to cauterized the internal
ovarian A. and ovarian branch of the
uterine A.
Divide tube with scissors

27. 2.
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M
esosalpinx Division
Divide the mesosalpinx with
scissors
Cauterize and divide the
infundibulo-ovarian ligaments
and the lateral tubal A.

28. 3.
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Extraction of the tube
Remove tube through an extraction
bag
Verification of hemostasis
Careful lavage
Removal of equipment
Suture/ Steri-strip laparoscopic
incisions
Cautio n:
•
Endometriosis
•
Utero-peritoneal fistula

29. Normal left adnxa
Normal left adnxa and Douglas pouch
Positive methyline blue test
Positive methyline blue test

30. Fine
adhesion
Fimbria
Fine band of
adhesion
Mild fimbrial adhesion
Fimbria
Broad band
of adhesion
Douglas
Pouch
Moderate adhesion
Fimbria

31. Severe Adhesions
Dr.Sherbiny

32. Hydrosalpinx

33. Uterus
L. Ovary
L. Tube
Adhesiolysis of the left tube with micro- scissor

34. Cutting band of adhesion
R .t
ube
R .Ovary

35. Phimosis: delayed
methyline blue spill
Dilatation with
Maryland forceps
Phimosis with
methyline Blue jet
Dr.Sherbiny
Free methyline
blue spill
Phimosis of the fimbrial end: Dilatation with Maryland forceps

36. Typical Endometriosis
Black Endometriosis
Blue Endometriosis
Black
Blue
Classic bluish black endometriotic implants

37. Atypical Endometriosis
Yellow Brown Endometriosis
Red Endometriosis(Flam-like)
Peritoneal Defect
White Endometriosis

38. Yellow Brown Endometriosis
Clear Endometriosis
Red Endometriosis (Pink)

39. Endometriotic Cyst
=
Endometrioma

40. PCO

41. PCOS: Laparoscopic Drilling
Laparoscopic ovarian drilling with either
diathermy or laser is an effective treatment
for anovulation in women with
clomiphene-resistant PCOS.
RCOG Guidelines : Grade A
58
National Institute of Clinical Excellency
(NICE) 2004

42. Tubal bipolar coagulation
Salpingostom
y
Cutting of the medial
part of the tube
Salpingostom
y
Laparoscopic tubal occlusion & salpingostomy of
Hydrosalpinges prior to IVF to improve pregnancy rate

43. COMPLETE SPECIMENN

44. ADVANTAGES
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QUICK RECOVERY
EARLY ORAL FEEDING
EARLY AMBULATIONS
BLADDER DYSFUNCTION IS LESS
POSTOPERATIVE COMPLICATIONS ARE
LESS

45. COMPLICATIONS
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1] Bowel injury
2] Vascular injury
3] Bladder injury
4] Cautery burns to surrounding organs
5] Anesthesia complications
6] Surgical emphysema etc.,

46. THANK YOU