Pediatric and Adolescent Gynecologic Laparoscopy

In: Infertility and Assisted Reproduction · 2008 · pp. 82–90 · doi:10.1017/cbo9780511547287.012 · W1945850629
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This chapter reviews laparoscopy's application in diagnosing and treating pelvic pain, adnexal masses, and PID in pediatric and adolescent patients, including incidental appendectomy, while emphasizing conservative surgical approaches for future fertility.

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This chapter discusses how laparoscopy by gynecologists can be performed in pediatric and adolescent patients, focusing on specialized instrumentation needs, preoperative considerations, and general operative techniques. It states that although laparoscopy has many indications, the main focus in this population is diagnosis and treatment of pelvic pain, adnexal masses, and pelvic inflammatory disease, and it also addresses incidental appendectomy. A key limitation is that the chapter frames pediatric-adolescent laparoscopy as relatively new and explains that earlier attempts were hindered by small-scope visualization quality before high-quality miniaturized instrumentation became available. Relevance to endometriosis: the chapter cites endometriosis in adolescents and notes appendectomy in patients undergoing laparoscopic surgery for pelvic pain, including literature such as “Endometriosis in an adolescent population,” though its main focus is pediatric/adolescent gynecologic laparoscopy rather than endometriosis treatment specifically.

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Abstract

This chapter focuses on the use of laparoscopy in treatment and diagnosis of patients with pelvic pain, adnexal masses, and pelvic inflammatory disease (PID). A discussion of incidental appendectomy in these patients will also be presented. The decision to perform incidental appendectomy is based on the premise that the appendix is a vestigial, functionless organ, with the potential only to contribute to pathological change. PID can have devastating consequences to adolescent females. With the advent of in vitro fertilization, surgeons should attempt to perform the most conservative surgery that is safely possible, in order to maintain the option of future childbearing. Diagnosis of endometriosis should not be delayed in adolescents. A delay may not only postpone symptomatic relief but also worsen the patient's future fertility and allow the disease to progress. Laparoscopy, as it applies to the pediatric and adolescent population, is a relative newcomer to the field.
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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 SYNOPSIS The use of laparoscopy by gynecologists in treating pediatric and adolescent patients is a relatively new phenomenon. We present the specialized instrumentation prerequisite to operating on patients in the pediatric-adolescent age-group. Preoperative considerations and generalized techniques unique to this population are discussed. Though laparoscopy has a myriad of indications, the main focus will be on treatment and diagnosis of pelvic pain, adnexal masses, and pelvic inflammatory disease. A discussion of incidental appendectomy in these patients will also be presented. INTRODUCTION Endoscopic surgery dates back to the Babylonian Talmud (Niddah Treatise, Section 65b). A lead funnel with a bent mouthpiece was introduced into the vagina, enabling direct visualization of the cervix. The first true laparoscopic procedure is credited to Ott in 1901, when he inserted a speculum through a small incision and, using a head mirror to focus light through the incision, inspected the abdominal viscera. Since that time, advances in the field have allowed surgeons to perform ever more complicated and intricate procedures. Of all the fields of surgery to benefit from laparoscopy, pediatric surgery is considered the newcomer. It was not until the production of high-quality, miniaturized instrumentation that surgeons began to look for applications of laparoscopy in the pediatric patient population. Few procedures were performed laparoscopically in this age-group before 1970 mainly because attempts at making smaller scopes resulted in unacceptable poor visualization. - Type - Chapter - Information - Infertility and Assisted Reproduction , pp. 82 - 90Publisher: Cambridge University PressPrint publication year: 2008 Laparoscopic appendectomy. J Am Assoc Gynecol Laparosc 2003;10(2):166–8.CrossRefGoogle ScholarPubMed , . Appendectomy under local anesthesia following conscious pain mapping: a report of two cases. Hum Reprod 1998;13(3): 588–90.CrossRefGoogle Scholar , , . Prospective evaluation of laparoscopic appendectomy in women with chronic right lower quadrant pain. J Am Assoc Gynecol Laparosc 1995;2(2):139–42.CrossRefGoogle ScholarPubMed , . Sonographic differentiation of benign versus malignant adnexal masses. UpToDate, 2004.Google Scholar . Appendectomy during childhood and adolescence and the subsequent risk of cancer in Sweden. Pediatrics 2003;111(6 Pt 1):1343–50.CrossRefGoogle ScholarPubMed , , , et al. . Infections of the upper genital tract. In: , , , ., eds. . Chronic pelvic pain: steps to take before and after operative intervention. In: , ed. Pediatric Laparoscopy and Thoracoscopy. Philedelphia: W.B. Saunders Company; 1994:6–16.Google Scholar . Instrumentation for endoscopic surgery. In: , ed. Macroscopic assessment of the appendix at diagnostic laparoscopy is reliable. Surgical Endoscopy 2000;14(7):625–33.CrossRefGoogle ScholarPubMed , , , . , . Dysmenorrhea, pelvic pain, and the premenstrual syndrome. In: , , , eds. Appendectomy in patients undergoing laparoscopic surgery for pelvic pain. J Am Assoc Gynecol Laparosc 2001;8(4):542–4.CrossRefGoogle ScholarPubMed , , . The appendix in relation to neoplastic disease. Cancer 1964;17:929–37.3.0.CO;2-O>CrossRefGoogle ScholarPubMed . Cancer risk following appendectomy for acute appendicitis. Cancer Causes Control 1998;9(2):183–7.CrossRefGoogle ScholarPubMed , , , , . A prospective study of appendectomy and predisposition to cancer. Surg Gynecol Obstet 1974;138(4):549–53.Google Scholar , , , . Wound sepsis after cholecystectomy. Influence of incidental appendectomy. J Clin Gastroenterol 1986;8(4):435–7.CrossRefGoogle Scholar , , . Appendectomy in the surgical treatment of endometriosis. Obstet Gynecol 1983;61(4):421–4.Google ScholarPubMed . Endometriosis in an adolescent population: the Emory experience. J Pediatr Adolesc Gynecol 1996;9(9):125–8.CrossRefGoogle Scholar , , . Pediatric and Adolescent Gynecology. 2nd edn. Philadelphia: Lippincott Williams and Wilkins; 2000:287–9.Google Scholar , . Pelvic pain in children and adolescents. In: , , eds. Pediatric and Adolescent Gynecology. 2nd edn. Philadelphia: W.B. Saunders Company; 2001:640–9.Google Scholar , . Chronic pelvic pain—medical and surgical approaches. In: , , , , eds. Pediatric Laparoscopy and Thoracoscopy. Philedelphia: W.B. Saunders Company; 1994:1–5.Google Scholar . History of pediatric laparoscopy and thoracoscopy. In: , ed. , , . Noninflammatory ovarian masses in girls and young women. Obstet Gynecol 2000;96(2):229–33.Google ScholarPubMed , , , . Endometriosis invading the bladder removed from a patient who had never menstruated. Proc R Soc Med 1925–1926; 19:15.Google Scholar . 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