8: LAPAROSCOPIC PROCEDURES Flashcards
% adhesion formation of omentum
68%
% adhesion formation of small intestine
67%
% adhesion formation of colon
41%
Dissecting avascular adhesions
Blunt traction/countertraction
Sharp
What has the greatest thermal spread out of monopolar, bipolar, ultrasonic?
Bipolar > Monopolar > Ultrasonic
% of ectopics in fallopian tube
90%
RFs ectopic
Previous ectopic
Fallopian tube damage
Prior tubal surgery
Prior pelvic surgery
ART
Smoking
1/2 have no RFs
Indications for salpingectomy over salpingostomy for ectopic
Salpingectomy preferred if:
Tubal damage or extensive bleeding from tube
Appropriate if desired future fertility and LSC evidence of healthy contralateral fallopian tube
Indications for salpingostomy over salpingectomy for ectopic
Salpingostomy preferred if:
Desire future fertility or evidence of damage to contralateral fallopian tube/someone who would require ART if salpingectomy is performed
Residual trophoblastic disease after salpingostomy may be as high as __%
20%
How to decrease risk of residual trophoblastic tissue after salpingostomy
Consider MTX prior
Difference in recurrent ectopic rate after salpingectomy vs salpingostomy?
RCT shows no difference in recurrent ectopics or IUP rates when comparing the two
Post-op care after salpingostomy
Follow bhcg to 0 (even if path shows trophoblastic tissue)
Indications for ovarian cystectomy
Benign
Intact technique to leave functional ovary in place
Do you need to reconstruct ovary after cystectomy?
Not unless needed for hemostasis (it will heal by secondary intention)
Hemostatic options for ovary
Minor bleeding - hemostatic agents (ex: topical thrombin, fibrin sealant)
Moderate bleeding - suture ligation, electrosurgery
Severe uncontrolled bleeding - consider oophorectomy
Oophorectomy infications
Benign ovarian neoplasm not amenable to cystectomy
Risk-reducing surgery (ex: ovarian or breast cancer)
Ovarian torsion or non-viable ovary
TOA refractory to conservative management
Cancer
Gender dysphoria with no desire for future fertiility
RFs ovarian torsion
Reproductive age
Ovarian mass >5cm
Pregnancy (especially between 11-17w)
Ovulation induction
Prior torsion
Sensitivity of US for ovarian torsion
40-75%
When to do oophorectomy after torsion
If obvious necrosis
If ovary is black with gelatinous/friable tissue
In post-menopausal to prevent recurrence
If malignancy is suggested, salpingoophorectomy is recommended
Prevention of ovarian torsion recurrence
Ovarian cyst suppression (hormonal)
Oophoropexy or shortening of uteroovarian ligament (consider if recurrent torsion, torsion of normal ovaries, or if ovary is greatly enlarged but without discrete mass
Fibroids are reason for ___ of hysterectomies
1/3
Benefits of LSC myomectomy over open
Reduced pain
Decreased fever
Shorter hospitalization
Difference in pregnancy rates, recurrence rates, and uterine rupture rates for LSC vs open myomectomy
Unchanged
