Microlaparoscopy

In: Infertility and Assisted Reproduction · 2008 · pp. 76–81 · doi:10.1017/cbo9780511547287.011 · W1553142324
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Microlaparoscopy enables rapid, minimally invasive gynecologic procedures for diagnostics and interventions like infertility assessment and endometriosis management, often allowing same-day discharge.

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This chapter reviews the historical development and rationale of microlaparoscopy as a miniaturized form of laparoscopy using very small (2–5 mm) instruments to reduce surgical trauma compared with conventional laparoscopy, and it places these advances within broader improvements in visualization technology such as fiber optics and CO2 insufflation. It outlines key milestones in laparoscopy and notes that gynecologic surgery has increasingly shifted from laparotomy to laparoscopic approaches with presumed lower morbidity and faster recovery. The stated limitation is that the provided text is largely an introduction/history and does not present new empirical outcomes or a detailed method-level evaluation of microlaparoscopy beyond describing its evolution and intended advantages. Relevance to endometriosis: it is included in the endometriosis/adenomyosis corpus because the chapter is in a fertility and infertility evaluation book that cites prior work on microlaparoscopy in pelvic pain and references endometriosis-associated infertility elsewhere in the volume, though this specific excerpt focuses on microlaparoscopy history rather than endometriosis mechanisms or outcomes.

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Abstract

Microlaparoscopy offers the advantage of carrying out many diagnostic and operative gynecologic procedures in a rapid, minimally invasive approach. Proper patient selection is very important for the success of the procedure. Microlaparoscopy could be performed either with general anesthesia or with local anesthesia under conscious sedation, which is a state of depressed consciousness allowing communication with the patient during the procedure. An umbilical incision is made (a local anesthetic block is done first in a case of conscious sedation) through which the interlocking trocar with the Verres needle is introduced to the abdomen. Most of the patients can leave the office within one hour of the procedure. Microlaparoscopy is currently used for infertility assessment, surgical management of endometriosis, lysis of pelvic adhesions, ovarian drilling, gamete intrafallopian transfer, tubal embryo transfer, hydrosalpinx removal before in vitro fertilization (IVF), and management of ectopic and heterotopic pregnancy.
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- Frontmatter - Contents - Contributors - Foreword - Preface - Introduction - PART I PHYSIOLOGY OF REPRODUCTION - PART II INFERTILITY EVALUATION AND TREATMENT - 6 Evaluation of the Infertile Female - 7 Fertiloscopy - 8 Microlaparoscopy - 9 Pediatric and Adolescent Gynecologic Laparoscopy - 10 Laparoscopic Tubal Anastomosis - 11 Tubal Microsurgery versus Assisted Reproduction - 12 The Future of Operative Laparoscopy for Infertility - 13 Operative Hysteroscopy for Uterine Septum - 14 Laser in Subfertility - 15 Ultrasonography of the Endometrium for Infertility - 16 Ultrasonography of the Cervix - 17 Transrectal Ultrasonography in Male Infertility - 18 The Basic Semen Analysis: Interpretation and Clinical Application - 19 Evaluation of Sperm Damage: Beyond the WHO Criteria - 20 Male Factor Infertility: State of the ART - 21 Diagnosis and Treatment of Male Ejaculatory Dysfunction - 22 Ovulation Induction - 23 Clomiphene Citrate for Ovulation Induction - 24 Aromatase Inhibitors for Assisted Reproduction - 25 Pharmacodynamics and Pharmacokinetics of Gonadotrophins - 26 The Future of Gonadotrophins: Is There Room for Improvement? - 27 Ovarian Hyperstimulation Syndrome - 28 Reducing the Risk of High-Order Multiple Pregnancy Due to Ovulation Induction - 29 Hyperprolactinemia - 30 Medical Management of Polycystic Ovary Syndrome - 31 Surgical Management of Polycystic Ovary Syndrome - 32 Endometriosis-Associated Infertility - 33 Medical Management of Endometriosis - 34 Reproductive Surgery for Endometriosis-Associated Infertility - 35 Congenital Uterine Malformations and Reproduction - 36 Unexplained Infertility - 37 “Premature Ovarian Failure”: Characteristics, Diagnosis, and Management - PART III ASSISTED REPRODUCTION - PART IV ETHICAL DILEMMAS IN FERTILITY AND ASSISTED REPRODUCTION - Index - Plate section - References from PART II - INFERTILITY EVALUATION AND TREATMENT Published online by Cambridge University Press: 04 August 2010 Book contents - Frontmatter - Contents - Contributors - Foreword - Preface - Introduction - PART I PHYSIOLOGY OF REPRODUCTION - PART II INFERTILITY EVALUATION AND TREATMENT - 6 Evaluation of the Infertile Female - 7 Fertiloscopy - 8 Microlaparoscopy - 9 Pediatric and Adolescent Gynecologic Laparoscopy - 10 Laparoscopic Tubal Anastomosis - 11 Tubal Microsurgery versus Assisted Reproduction - 12 The Future of Operative Laparoscopy for Infertility - 13 Operative Hysteroscopy for Uterine Septum - 14 Laser in Subfertility - 15 Ultrasonography of the Endometrium for Infertility - 16 Ultrasonography of the Cervix - 17 Transrectal Ultrasonography in Male Infertility - 18 The Basic Semen Analysis: Interpretation and Clinical Application - 19 Evaluation of Sperm Damage: Beyond the WHO Criteria - 20 Male Factor Infertility: State of the ART - 21 Diagnosis and Treatment of Male Ejaculatory Dysfunction - 22 Ovulation Induction - 23 Clomiphene Citrate for Ovulation Induction - 24 Aromatase Inhibitors for Assisted Reproduction - 25 Pharmacodynamics and Pharmacokinetics of Gonadotrophins - 26 The Future of Gonadotrophins: Is There Room for Improvement? - 27 Ovarian Hyperstimulation Syndrome - 28 Reducing the Risk of High-Order Multiple Pregnancy Due to Ovulation Induction - 29 Hyperprolactinemia - 30 Medical Management of Polycystic Ovary Syndrome - 31 Surgical Management of Polycystic Ovary Syndrome - 32 Endometriosis-Associated Infertility - 33 Medical Management of Endometriosis - 34 Reproductive Surgery for Endometriosis-Associated Infertility - 35 Congenital Uterine Malformations and Reproduction - 36 Unexplained Infertility - 37 “Premature Ovarian Failure”: Characteristics, Diagnosis, and Management - PART III ASSISTED REPRODUCTION - PART IV ETHICAL DILEMMAS IN FERTILITY AND ASSISTED REPRODUCTION - Index - Plate section - References INTRODUCTION The history of endoscopies goes back to 1805 when Bozzani managed to visualize the urethra using a very primitive tool known as Lichtleiter that depended on a candle as a light source (1). It was not until 1910, when the term laparoscopy was designated by Jacobaeus (2), who reported the first human laparoscopy using a Nitze cystoscope (3) to visualize different body cavities, although he did not employ pneumoperitoneum at that time. Fevers (4) was the first to report operative laparoscopy in 1933, when he performed the lysis of some adhesions and obtained a number of biopsies. In the 1940s, extensive laparoscopic research was done by Palmer (5) who advocated the use of Trendelenburg position for improved visualization during laparoscopy and later was the first to report human oocyte retrieval in 1961 (6). Further technological advancements in the field of fiber optics along with the introduction of automatic CO2 insufflators in the 1970s dramatically improved laparoscopic procedures (7). The introduction of laparoscopy in the field of gynecology was a historic landmark as it gradually replaced the traditional laparotomy. Currently, most of the gynecologic surgeries are performed laparoscopically, which undoubtedly decreased the rate of morbidity and complications along with hastening the patient recovery. In order to decrease the surgical trauma during endoscopic procedures, miniatures of traditional laparoscopies utilizing instruments 2–5 mm in diameter were developed (8, 9) and were known as minilaparoscopy or microlaparoscopy. - Type - Chapter - Information - Infertility and Assisted Reproduction , pp. 76 - 81Publisher: Cambridge University PressPrint publication year: 2008 , . The history of the cystoscope. In , ed., Uber die Moglichkeit die Zystoskopie bei Untersuchung seroser Hohlungen anzuwenden. Munch Med Wochenschr 1910;57:2090–2.Google Scholar . Uber eine neue Beleuchtungsmethode der Hohlen des menschlichen Korpers. Wien Med Presse 1879;20:851–8.Google Scholar . 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J Am Assoc Gynecol Laparosc 1997;4(5):591–4.CrossRefGoogle ScholarPubMed , , . Microlaparoscopy in gynecology: analysis of 16 cases and review of literature. Rev Hosp Clin Fac Med Sao Paulo 2001; 56(4):115–18.CrossRefGoogle ScholarPubMed , , , , , . Appendectomy under local anaesthesia following conscious pain mapping with microlaparoscopy. Hum Reprod 1998;13(3):588–90.CrossRefGoogle ScholarPubMed , , . Laparoscopy in the “normal” infertile patient: a question revisited. J Am Assoc Gynecol Laparosc 2000;7(3):317–24.CrossRefGoogle ScholarPubMed , , . Accuracy of diagnostic laparoscopy in the infertility work-up before intrauterine insemination. Fertil Steril 2003;79:361–6.CrossRefGoogle ScholarPubMed , , . Endoscopy in the evaluation of the woman experiencing infertility. Clin Obstet Gynecol 2000;43(4):889–96.CrossRefGoogle ScholarPubMed . Adhesion formations and reproductive outcome after myomectomy and second-look laparoscopy. Obstet Gynecol 1993;82:213–15.Google Scholar , , . Effects of Ringer's lactate, Interceed (TC&) and Gene-Tex surgical membrane or postsurgical adhesion formation. Fertil Steril 1992;57:199–201.CrossRefGoogle ScholarPubMed , . Adverse effects of hydrosalpinx on pregnancy rates after in vitro fertilization-embryo transfer. Fertil Steril 1998;70:492.CrossRefGoogle ScholarPubMed , , . Surgical management of adhesions, endometriosis, and tubal pathology in the woman with infertility. Clin Obstet Gynecol 2000;43(4):916–28.CrossRefGoogle ScholarPubMed , , . Salpingectomy improves the pregnancy rate in in-vitro fertilization with hydrosalpinx. Hum Reprod 1996;11:523–5.CrossRefGoogle ScholarPubMed , , , , . Laparoscopic salpingectomy for women with hydrosalpinges enhances the success of IVF: a Cochrane review. Hum Reprod 2002;17:543.CrossRefGoogle ScholarPubMed , , . Practice Committee of the American Society for Reproductive Medicine. Salpingectomy for hydrosalpinx prior to in vitro fertilization. Fertil Steril 2006;86 (Suppl. 5):S200–1. National Institute of Clinical Excellence. Fertility: assessment and treatment of people with fertility problems, Clinical guidelines No. 11. London: Abba Litho Ltd UK, 2004. Surgical management of adhesions, endometriosis, and tubal pathology in the woman with infertility. Clin Obstet Gynecol 2000;43(4):916–28.CrossRefGoogle ScholarPubMed , , . Surgical treatment of endometriosis via laser laparoscopy. Fertil Steril 1986;45(6):778–83.CrossRefGoogle ScholarPubMed , , . on behalf of the ESHRE Special Interest Group for Endometriosis and endometrium Guideline Development Group. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 2005;20(10):2698–704.CrossRefGoogle Scholar , , , , , , , , ; Surgical treatment in polycystic ovary syndrome. Curr Opin Obstet Gynecol 2006;18(3):286–92.CrossRefGoogle ScholarPubMed , . Laparoscopic “drilling” by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome. Cochrane Database Syst Rev 2005;(3):CD001122.CrossRefGoogle ScholarPubMed , , , . Manual of ovulation Induction. Mumbai: India, Rotunda Medical Technologies, 2001, chapter 18, 140–4.Google Scholar , . Laparoscopic ovarian drilling for ovulation induction in polycystic ovarian syndrome. In (Ed.) Ovarian hyperstimulation syndrome. Cambridge: United Kingdom, Cambridge University Press, 2006, chapter 7, 130–99.Google Scholar . Prevention of ovarian hyperstimulation syndrome. In (Ed.) Accessibility compliance for the PDF of this chapter is currently unknown and may be updated in the future. To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle. Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service. - Microlaparoscopy - - Book: Infertility and Assisted Reproduction - Online publication: 04 August 2010 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox. - Microlaparoscopy - - Book: Infertility and Assisted Reproduction - Online publication: 04 August 2010 To save content items to your account, please confirm that you agree to abide by our usage policies. 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