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This paper reports three cases of postoperative adhesions causing abdominal/pelvic pain that were treated with laparoscopic adhesiolysis using a KTP 532 laser (10–15 W). Filmy peritubular and periovarian adhesions were described as easily vaporized, while denser, vascular adhesions (including peritubular/periovarian and omental adhesions) were more difficult to treat and required surgical ligation of blood vessels. All three cases reported immediate disappearance of their complaints after the procedure, and the authors conclude that KTP laser adhesiolysis is effective and minimally invasive for adhesions following gynecologic operations; the main explicit limitation is the very small sample size (n=3) and lack of comparative evaluation. Relevance to endometriosis and/or adenomyosis: Case 3 involves postoperative endometriosis with an ovarian “chocolate cyst” adherent to pelvic structures and persistent dysmenorrhea after hormonal therapy, followed by symptom resolution after adhesiolysis.
Abstract
Three cases, who had postoperative adhesions, carried out a laparoscopic adhesiolysis with KTP 532 laser.Filmy peritubular and periovarian adhesions were easily vaporized with the KTP 532 laser, visible green-light-laser. The power of 10 to 15 watts was used for laser vaporization of adhesions. It was difficult to treat the more dense, vascular adhesions, such as peritubular, periovarian and omentum adhesions. Surgical ligation of blood vessels was necessary in the more dense adhesions.Case-1: 38 year-old woman, 2G2P, was underwent the partial cystectomy for the ovarian chocolate cyst 2 years ago. Laparoscopic examination revealed the presence of dense and vascular adhesions in the pelvic cavity.Case-2: 44 year-old woman, 2G2P, who was underwent the total abdominal hysterectomy for the uterine leiomyoma, visited the our devision for severe pelvic pain. Laparoscopic examination revealed the adhesions within bilateral adnexa slightly. Omentum were adherent to the peritoneal wall extensively.Case-3: 22 year-old, 1G0P, She had still severe dysmenorrhea after hormonal therapy for postoperative endometriosis. The chocolate cyst was adherent to the cul-de sac and posterior surface of the uterus. Massive adhesion were found in the omentum and peritoneal wall.These complaints of all cases were immediately disappeared after laparoscopic adhesiolysis.In conclusion, the adhesiolysis with KTP laser is more effective and minimum invasive treatment for adhesions of post gynecologic operations.
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術後癒着性腹痛に対するレーザー手術
1992 年 13 巻 Supplement 号 p. 413-416
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Three cases, who had postoperative adhesions, carried out a laparoscopic adhesiolysis with KTP 532 laser.
Filmy peritubular and periovarian adhesions were easily vaporized with the KTP 532 laser, visible green-light-laser. The power of 10 to 15 watts was used for laser vaporization of adhesions. It was difficult to treat the more dense, vascular adhesions, such as peritubular, periovarian and omentum adhesions. Surgical ligation of blood vessels was necessary in the more dense adhesions.
Case-1: 38 year-old woman, 2G2P, was underwent the partial cystectomy for the ovarian chocolate cyst 2 years ago. Laparoscopic examination revealed the presence of dense and vascular adhesions in the pelvic cavity.
Case-2: 44 year-old woman, 2G2P, who was underwent the total abdominal hysterectomy for the uterine leiomyoma, visited the our devision for severe pelvic pain. Laparoscopic examination revealed the adhesions within bilateral adnexa slightly. Omentum were adherent to the peritoneal wall extensively.
Case-3: 22 year-old, 1G0P, She had still severe dysmenorrhea after hormonal therapy for postoperative endometriosis. The chocolate cyst was adherent to the cul-de sac and posterior surface of the uterus. Massive adhesion were found in the omentum and peritoneal wall.
These complaints of all cases were immediately disappeared after laparoscopic adhesiolysis.
In conclusion, the adhesiolysis with KTP laser is more effective and minimum invasive treatment for adhesions of post gynecologic operations.
Filmy peritubular and periovarian adhesions were easily vaporized with the KTP 532 laser, visible green-light-laser. The power of 10 to 15 watts was used for laser vaporization of adhesions. It was difficult to treat the more dense, vascular adhesions, such as peritubular, periovarian and omentum adhesions. Surgical ligation of blood vessels was necessary in the more dense adhesions.
Case-1: 38 year-old woman, 2G2P, was underwent the partial cystectomy for the ovarian chocolate cyst 2 years ago. Laparoscopic examination revealed the presence of dense and vascular adhesions in the pelvic cavity.
Case-2: 44 year-old woman, 2G2P, who was underwent the total abdominal hysterectomy for the uterine leiomyoma, visited the our devision for severe pelvic pain. Laparoscopic examination revealed the adhesions within bilateral adnexa slightly. Omentum were adherent to the peritoneal wall extensively.
Case-3: 22 year-old, 1G0P, She had still severe dysmenorrhea after hormonal therapy for postoperative endometriosis. The chocolate cyst was adherent to the cul-de sac and posterior surface of the uterus. Massive adhesion were found in the omentum and peritoneal wall.
These complaints of all cases were immediately disappeared after laparoscopic adhesiolysis.
In conclusion, the adhesiolysis with KTP laser is more effective and minimum invasive treatment for adhesions of post gynecologic operations.
© 特定非営利活動法人 日本レーザー医学会
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