Practical Manual for Laparoscopic and Hysteroscopic Gynecological Surgery (with DVD Rom)

This new edition brings surgeons fully up to date with the latest developments and technologies in laparoscopic and
hysteroscopic gynaecological surgery. Beginning with the history, instruments and training of endoscopy, each chapter
focuses on a different condition, presenting surgical procedures in a step by step process, as well as possible
complications. The second edition includes new chapters on ovarian tumours, ectopic pregnancy and tubal surgery, as
well as an up to date reference list. Written by an extensive author and editor team from Europe, the USA and Canada,
this practical manual features nearly 750 full colour images and illustrations, and includes four interactive DVD ROMs
demonstrating surgical procedures described in the book. Key points *New edition presenting latest developments in
laparoscopic and hysteroscopic gynaecological surgery *Includes new chapters on ovarian tumours, ectopic pregnancy and
tubal surgery *Extensive author and editor team from Europe, USA and Canada *Includes nearly 750 colour images and
illustrations and four interactive DVD ROMs *Previous edition published in 2006


Contents
1. Historical Perspective 1
Thoralf Schollmeyer, Kurt Semm(†), Manfred Schollmeyer, Liselotte Mettler
2. Instruments and Equipment for Laparoscopic Surgery 11
Liselotte Mettler
• Instruments 12 • Energy Systems for Operative Laparoscopy 18 • Articulated Instruments 24
• Single Port Endoscopic Entry 25
3. Current Laparoscopic Training Models 29
Andreas Hackethal, Julia Ionesi-Pasacica, Hans-Rudolf Tinneberg
• Pelvitraining and Video Training 29 • Virtual Reality Training 30
4. Current Training Models In Hysteroscopy 33
Flemming Bjerrum
• Theoretical Curriculum 33 • Training Models 33 • What to Consider before Performing Real
Procedures? 34 • Assessment/Certification 34
5. Peritoneal Access 37
Liselotte Mettler, Bruno Van Herendael, Andrea Tinelli, Antonio Malvasi, Artin Ternamian
• Endoscopic Threaded Imaging Port 37 • Gynecological Laparoscopy and Imaging 40
6. Risk Management in Gynecologic Endoscopy 59
Artin Ternamian
• Definitions 59 • Commitment to Risk Management 61 • Risk Assessment 68
• Tips and Tricks 68 • Photo and Video Consent Form 69
7. Descriptive and Functional Anatomy of the Female Pelvis 72
Bruno Van Herendael, Michel Degueldre, Jean Vandromme, Benedikt Tas
• The Anterior Compartment 73 • The Mid Compartment 75 • The Posterior Compartment 77
8. Female Pelvis Innervation and Vascularization in Laparoscopy 82
Andrea Tinelli, Roberta Montefrancesco, Giovanni Alemanno, Antonio Malvasi
• Laparoscopy in Extraperitoneal Spaces 83 • Vascularization and the Lymphatic System in Laparoscopy 83
• Female Pelvic Nervous System 86
9. Suturing and Ligature Techniques at Laparoscopy 91
Liselotte Mettler, Goentje Peters, Tamer Seckin, Bruno Van Herendael, Ibrahim Alkatout
• Hemostasis by Loop Ligatures 91 • Hemostasis by Endoligature or Endosuture and
Extracorporeal Knotting 91 • Hemostasis by Endosuture with Intracorporeal Knotting 92
• Hemostasis by Suture and Tying Knot with Half Hitch 95 • Needles and Sutures 95
• Tips and Tricks 100
10. General Surgery Conditions and Techniques for Gyne-Endoscopic Surgeons 102
John E Morrison
• Abdominal and Pelvic Wall 102 • Umbilical Hernias 102 • Incisional Hernias 103
• When and How? 104 • Procedure 104 • Special Considerations 105
• Inguinal Hernias 106 • Special Considerations 107 • Internal Hernias 108
• Visceral Pathologies 108 • Colon 108 • Appendix 109 • Small Bowel 110
xxiv Practical Manual for Laparoscopic and Hysteroscopic Gynecological Surgery
11. Pneumoperitoneum 115
Douglas E Ott
• Desiccation Effects 117 • Tips and Tricks of the Trade 121
12. Benign Ovarian Tumors 125
Saeed Alborzi, Bahareh Hamedi
• Preoperative Evaluation 125 • Surgical Approach 126 • Suturing in Ovarian Surgery 132
• Tips and Tricks 134
13. Ectopic Pregnancy 138
Ibrahim Alkatout
• Step 1 138 • Step 2 140 • Step 3 145 • Step 4 145 • Step 5 147 • Step 6 148 • Step 7 149
• Step 8 149 • Step 9 149
Surgical Technique for Nontubal Ectopic Pregnancy 150
• Step 10 150 • Step 11 153 • Step 12 153 • Step 13 154 • Step 14 154 • Step 15 155
• Step 16 155
General Operative Steps after Removal of the Ectopic Pregnancy 155
• Step 17 155 • Step 18 155 • Step 19 155 • Step 20 156 • Tips of the Experts 157
14. Endoscopic Surgery in Pregnancy 159
Wael Sammur, Liselotte Mettler
• Indications for Laparoscopic Surgery during Pregnancy 159 • Tips and Tricks 162
15. Extragenital Findings in Gynecological Laparoscopy 165
Ibrahim Alkatout, Friederike Egberts, Manfred Schollmeyer, Liselotte Mettler
• Step 1 165 • Step 2 165 • Step 3 165 • Step 4 166 • Step 5 170
• Step 6 170 • Step 7 172 • Step 8 172 • Step 9 172 • Step 10 180 • Step 11 184
• Tips of the Experts 184
16. Tubal Surgery 186
Sanjay Patel
• Types of Tubal Surgery 186 • Hysteroscopic Tubal Cannulation 186
• Laparoscopic Tubal Microsurgery 187 • Equipment and Instruments 187 • Selection of Cases 188
• Intraoperative Evaluation 189 • Surgical Technique 190 • Types of Anastomosis 191
• Author’s Experience 195 • Laparoscopic Salpingo-Ovariolysis and Fimbrioplasty 195
• Tips and Tricks 196
17. Tubal Torsion: The Diagnostic Dilemma 199
Ibrahim Alkatout, Thoralf Schollmeyer, Ivo Meinhold-Heerlein, Liselotte Mettler
• Operative Steps 200 • Summary and Complications 203 • Tips and Tricks 204
18. Endometriosis 205
Mauricio Simões Abrão, Sergio Podgaec, Luciano Gibran
• General Considerations 206 • Surgical Techniques 208
19. Rectal Endometriosis–Diagnostic Procedure and Therapeutic Concepts 219
J Marek Doniec, Mathias Löhnert
• What Kind of Preoperative Diagnostics? 219 • How to Manage Rectal Endometriosis? 220
20. Adhesiolysis and Prophylaxis of Adhesions 223
Hans-Rudolf Tinneberg, Andreas Hackethal
• Background 223 • Handling of Adhesions 223 • Outlook 226
Contents xxv
21. Fibroids 227
Ornella Sizzi, Alfonso Rossetti, Alessandro Loddo
• Preoperative Preparation 227 • Patient Positioning in the Operating Theater 227
• Standard Positioning and Placement of Trocars 228 • Alternative Positioning and Placement
of Trocars 228 • Instruments 228 • Operating Steps 228 • Postoperative Care 233
• Complications 233 • Results and Outcome 234 • Tips and Tricks of the Trade 235
22. Pelvic Floor Defects Surgery 238
Michael L Sprague, J Stephen Rich, Cy Liu
• Anatomy 238 • Preoperative Evaluation 238 • Uterosacral Ligament Suspension 239
• Laparoscopic Sacral Colpopexy 241 • Complete Pelvic Floor Reconstruction with Mesh 242
• Tips and Tricks of the Trade 245
23. Total Laparoscopic Hysterectomy 246
Thoralf Schollmeyer, Mohamed Elessawy
• Teaching Yesterday and Today 246 • How to Learn Laparoscopic Hysterectomy? 247
• Tips and Tricks for the Total Laparoscopic Hysterectomy 254
24. Technique of Routine Total Laparoscopic Hysterectomy with a Dissection of Uterine
Vessels at Internal Iliac Level and Using a Uterine Manipulator 256
Bernd Holthaus, Susanne Denny
• Preparation 256 • Trocars, Instruments and Start 256 • Opening of Pelvic Side Wall 256
• Identification and Dissection of Uterine Vessels at Internal Iliac Level 256 • With or Without Bilateral
Salpingo-Oophorectomy 257 • Dissection of Parametria and Sacrouterine Ligaments 258
• Removal of Uterus 258 • Results 258 • Tips and Tricks 260
25. Hysterectomies—Laparoscopic Subtotal Hysterectomy 261
Bernd Bojahr
• Surgical Procedure 261 • Complications 270
26. Laparoscopic Combined Hysterectomy Using The “Change Over Technique”
for Very Large Uterine Myomata 274
Garri Tchartchian
• Laparoscopic Combined Hysterectomy (For Uterus Over 1,000 Grams) 274 • Surgical Procedure 275
• Complications 277 • Summary 277 • Tips and Tricks 277
27. Laparoscopic Pectopexy 279
Karl Günter Noé
• A New Technique in Prolapse Surgery 279 • Procedures 279 • Equipment 283
• Tips and Tricks 284
28. Strategies to Prevent Vault Descent at the Time of Hysterectomy 285
Bruno Van Herendael
• Technique 285
29. Oncologic Surgery on the Ovary 290
Ivo Meinhold-Heerlein
• Summary 290 • Laparoscopy for Ovarian Malignancies: Prophylactic Operations 291
• Laparoscopy for Ovarian Malignancies: Borderline Tumors 291 • Laparoscopy for Ovarian
Malignancies: Early Stage Invasive Tumors 292 • Laparoscopy for Ovarian Malignancies: Advanced
Stage Invasive Tumors 293 • Indication and Preoperative Work-Up 293 • Laparoscopic Procedures 294
• Tips and Tricks 297
xxvi Practical Manual for Laparoscopic and Hysteroscopic Gynecological Surgery
30. Oncologic Surgery on the Uterus 300
Riddhi Desai, Amit Galagali, Seema Puntambekar, Geetanjali Agarwal, Shailesh Puntambekar
• Laparoscopic Radical Hysterectomy 300 • Laparoscopic Nerve Sparing Radical Hysterectomy 304
• Anterior Exenteration 305 • Robotic Radical Hysterectomy 311 • Single Incision Laparoscopic
Radical Hysterectomy 313
31. Robot Assisted Surgery in Gynecology 316
Kubilay Ertan, Alexander di Liberto
• Propaedeutics/ Definition/ Intent of Robot-Assisted Surgeries/Target 316
• Development/Technology of the da Vinci System 317 • Advantages and Disadvantages of the
da Vinci System 321 • Training/Learning Curve/Building a Team 322 • Preparation/Patient
Positioning/Covering/Communication 325 • Selection of Instruments/Uterine Manipulation/Use of the
Fourth Arm 327 • Fundamental Operation Sequence (Single Fundamental Operating Room Steps, Chart of
Operating Room Times) 330 • Trocar Placement (Principles/Possibilities)/Docking Maneuver/Docking
Possibilities 331 • Patient Selection/Selection Criteria (Initial Phase, Advanced Stage, etc.) 333
• Range of Robot-Assisted Gynecologic Procedures 334 • Specifics with Intraoperative Complications
or Complication Management 335 • Aspects of Patient Information/Specifics of Anesthesiology 337
• Economic Factors/Marketing 338 • Further Developments/Future Models 339
• Significance of Robotic Systems within Minimally Invasive Surgery 339 • Tips and Tricks 340
• Video Register 342
32. Diagnostic Hysteroscopy and Office Hysteroscopy 346
Lotte Clevin
• Instruments and Equipments 346 • Preparations 347 • Tips and Tricks 353
33. Operative Hysteroscopy 357
Thomas Römer
• Indications for Operative Hysteroscopy 357 • Instrumentation and Technical Equipment 357
• Technique and Procedure of Operative Hysteroscopy 357 • Staff Requirements 357
• Surgical Interventions 358 • Summary 363
Index 365
„„CHAPTERS WITH DVD CONTENts
DVD-1
Chapter 4. Current Training Models in Hysteroscopy—Flemming Bjerrum
Video 1: Demonstration of an endometrial resection performed in a pig heart
Video 2: Demonstration of a myoma resection simulation on the HystSim
Video 3: Demonstration of bleeding and fluid management on the HystSim
Chapter 10. General Surgery Conditions and Techniques for Gyne-Endoscopic Surgeons—John E Morrison
Video 1: Inguinal floor with direct hernia
Video 2: Femoral hernia
Video 3: Ligation of appendix base
Video 4: Transection of appendix base
Chapter 12. Benign Ovarian Tumors—Saeed Alborzi, Bahareh Hamedi
Video 1: Laparoscopic ovarian cystectomy
Video 2: Laparoscopic resection of ovarian endometrioma and release of adhesions
Chapter 18. Endometriosis—Mauricio Simões Abrão, Sergio Podgaec, Luciano Gibran
Video 1: Surgical treatment–Infiltrating endometriosis
• Rectosigmoid
• Ileum
• Vermiform appendix
• Ovary
• Uterosacral ligaments
Video 2 : Surgical treatment–Infiltrating endometriosis
• Bladder
DVD-2
Chapter 21. Fibroids—Ornella Sizzi, Alfonso Rossetti, Alessandro Loddo
Video 1: Myomectomy 1
Video 2: Myomectomy 2
Video 3: Uterine fibroid
Video 4: Intraligamentous myoma
DVD-3
Chapter 22. Pelvic Floor Defects Surgery—Michael L Sprague, J Stephen Rich, CY Liu
Video 1: Uterosacral ligament uterine suspension
Video 2: Total pelvic floor reconstruction with mesh
Chapter 23. Total Laparoscopic Hysterectomy—Thoralf Schollmeyer, Mohamed Elessawy
Video 1: Laparoscopic subtotal hysterectomy (LASH) and Laparoscopic total hysterectomy (LTH)
Video 2: Total laparoscopic hysterectomy (TLH)
DVD-4
Chapter 27. Laparoscopic Pectopexy—Karl Günter Noé
Video 1: How to do Noé pectopexy
DVD Contents
xxviii Practical Manual for Laparoscopic and Hysteroscopic Gynecological Surgery
Chapter 29. Oncologic Surgery on the Ovary–Ivo Meinhold-Heerlein
Video 1: Fallopian tube carcinoma
Video 2: Ovarian tumor
Chapter 31. Robot Assisted Surgery in Gynecology—Kubilay Ertan, Alexander di Liberto
Video 1: Simple hysterectomy—complex case
Video 2: Radical hysterectomy