Laparoscopy is a well known minimal invasive surgery. This procedure places ports, which vary in size from 5 mm (less than 1/4 of an inch) to 12 mm (less than 1/2 an inch), throughout the abdomen. The abdomen is then distended with gas (CO2). A small telescope is introduced into the abdominal area for visual examination. This telescope is connected to a dedicated camera, a common feature in the performance of minimal invasive surgery, that can provide both a magnified or panoramic view using a video monitor. Additonal ports are typically required to place special instruments to operate (operative laparoscopy). Laser can also be used in a technique call video laser laparoscopy. Many surgeries are done utilizing this technique with good results in gynecology, general, pediatric, chest, orthopedic, urology and vascular surgery. These are hospital procedures usually done under general anesthesia. (Major contributions by Drs. R.Palmer- K. Seems .-T.F. Dillon-F. Nezhat- H. Reich- J.M. Phillips.)
Port: a point of entrance established with a trocar.
Trocar: a surgical instrument used to enter cavities consisting of a tube, either metalic or plastic, into which fits an obturator. Subsequently, the obturator is removed and the tube is used to place either a telescope or surgical instruments.
Microlaparoscopy: A procedure similar to laparoscopy that uses smaller ports placed in the abdomen. The size of these ports placed in the abdomen are less than 5 mm ( or 1/4 of an inch). This provide enough light for some procedure with less panoramic view than laparoscopy. other limitations are limited light. heavy suction, irrigation and extraction of surgical specimens. Advantages, better cosmetic results. less chances of complications associated with the use of larger ports. These procedure could be done under local or general anesthesia. This surgery is performed in office surgical suites or in hospital procedure.
Minilaparoscopy: also known as microlaparoscopy.
Hysteroscopy: is a telescopic view of the uterine cavity. rigid or flexible instruments are used for diagnostic and treatment of severe vaginal bleeding (metrorrhagia)., uterine polyps, uterine myomas ( fibroids)infertility, uterine septum, uterine deformities, uterine scars and post menopausal bleeding..
major contributions by Drs. R. Quinones- R.S. Neurewith, R.F. Valle, H.A. Goldfarb. This could be an office or hospital procedure . Could be done with either local or general anesthesia.. Could be done in a office or hospital depending the extent of the procedure.
Culdoscopy: A delicate surgical technique that places a port 5 mm to 12 mm in size in the vagina and into the pelvic cavity to visualize and operate. " One of the advantages of culdoscopy is that is a less traumatic procedure" than laparoscopy. Major contributions by Drs. A. Decker-E. Klaften-M. Cohen. Culdoscopy uses a rigid type of telescope for visualization. The visual angle of the telescopes vary form 0 to 90 degrees. A patient could be place lying down ( lithotomy) or in her knees ( knee -chest posture) for this operation. Distention may not be required in the knee-chest posture. most cases required gas distention for visualization. It is use for diagnostic in infertility , pelvic pain and surgeries like tubal ligation, ovarian cyst, lysis of adhesions, biopsy of endometriosis. This could be done with local, regional or general anesthesia.. Mostly is an Hospital procedure. was done occasional as an office procedure.
Flexible Culdoscopy: Uses 5 mm or smaller ports than in Culdoscopy. A flexible type of telescope allows a retroview by curving the flexible scope from 0 to 180 degree angles. Contribution by J.D. Paulson, J.W. Ross, S. El-Shawi. This is a new procedure the indications are similar than Culdoscopy. The advantage , no blind spots as in Culdoscopy ( the bottom of the cul-de-sac and the anterior face of the uterus).
Transvaginal Hydrolaparoscopy: related with Culdoscopy uses liquid for distention ( Normal saline at body temperature) using small diameter optics this procedure offers a less panoramic view than Laparoscopy, Microlaparoscopy or Culdoscopy. I use for diagnostic procedures mostly in infertility and minor operations in tubes, lysis of adhesions, ovarian cystectomies, ovarian drilling and vaporization of endometrials implants. Contributions by S. Gordts, R.Campo, L. Rombauts, I Bronsen. and also by A. Watrelot, D.J. Turner, J.M. Dreyfus, J.P. Andine, M. Cohen. Advantage is a well tolerated procedure could be done as an office procedure. without general anesthesia.
Culdoscopy Assisted Laparoscopy: Uses Culdoscopy to assist Laparoscopy or Microlaparoscopy. Takes the advantages of both techniques. From the less traumatic Culdoscopy , by placing the larger need port via the vaginal route. this port is use as visual and extracting. This allows the use of smallest abdominal ports for operative or place small telescopes like in Microlaparoscopy. The Culdoscopy entrance of the trocar is done under Laparoscopy surveillance. Contribution D.A. Tsin. New procedure for indications see Culdolaparoscopy. Use for major surgical operations in hospital procedures.
Culdolaparoscopy: Similar than Culdoscopy assisted laparoscopy surgery. Combines Laparoscopy and Microlaparoscopy with Culdoscopy. The functions of all ports can change from visual to an operative aid depending on the nature of the procedure or stage of the operation. Contribution by D.A. Tsin. new procedure was use successfully in Appendectomy, Cholecystecomy, Hysterectomy, Myomectomy, Oophorectomy Salpingoophorectomy
Salpingoophorectomy Tube and ovary
The advantage of Culdoscopy Assisted Laparoscopy Surgery and Culdolaparoscopy is to reduce the number as well as the size of the abdominal ports. This technique is cosmetically better, while at the same time reduces the risk of complications such hernias or injuries associated with bigger abdominal ports.