Laparoscopy

Prof. Dr. Rokshana Ivy

 Indications &
Contraindications
Indications of laparoscopy in
gynaecology

Indications will increase with the technical

innovations and clinician’s experiences.

A) Diagnostic
B) Evaluation
C) Therapeutic
A) Diagnostic
 Differentiate among uterine, oarian and tubal
masses
 Pelvic pain
 Genital anomalies
 Ascitis
 Pelvic injuries
 Occult cancer
B) Evaluation
 Infertility
 Second look
 Peritoneal washing for cytology
 Peritoneal culture ( tuberculosis &

Actinomyses)
 Evaluation of uterine perforation
C) Therapeutic
 Treatment of ectopic pregnancy
 Ovarian tumour
 TLH,LAVH and laparoscopic subtotal hysterectomy
 Endometriosis: adhesiolysis, fulguration,
cystectomy, hysterectomy
 Reconstructive surgery for POP and urinary
incontinence
 Tubal sterilization
 Removal of extruded IUD
 GIFT
Contraindications

Absolute

 Massive haemorrhage
 Generalized peritonitis
 Intestinal obstruction
Relative

 Severe pulmonary and cardiac disease

 Previous periumbilical surgery
 Cancer involving anterior abdominal wall
 Intrauterine pregnancy after the 1st and early

2nd trimester
 Known severe intraperitoneal adhesions
Complications
 Complications related to laparoscopy in gynaecologic patients - 0.1 to
10%

 Nonoperative or minor procedures--0.06 to 7%

 Major operations----------------0.6 to 18%

 Over 50% occur------------------at entry

 20 to 25% not recognized until the post operative period

 Conversion to laparotomy----------2.1%

 Mortality ------------------------4.4 per 100,000 laparoscopies

Types of complications
 Anesthesiological complications

 Operative complications
a) trocar entry complications
b) intraoperative complications
c) early post operative
d) late post operative
Anesthesiological complications
 Cardiac arrhythmias: bradycardia, sinus
tachycardia, ventricular tachycardia
 Cardiac arrest
A)Pneumoperitoneum related D) Venous thrombosis
i) Hypercarbia
E) Hernia
ii) Emphysema
iii) gas embolism
iv)Postoperative F) Port site metastasis
Shoulder pain
B) Injuries
i) vascular injury
ii)gastrointestinal tract injury
iii) urinary tract injury
iv) nerve injury
Vascular injury
 Retroperitoneal major vascular injuries are
mortal
 Inferior epigastric vessel injury is the most

common type of vessels injury

 Sup and Inf Epigastric
Major vessels
arteries
Gastrointestinal tract injury
 Incidence is about 0 to 0.5%
 About 50% at the time of entry
 Entry related injuries are mostly lacerated
 Intraoperative injuries are mostly thermal
Urinary tract injury
 Incidence is about 0.02 to 01.7%
 Bladder injury is more common than ureteral

injury
 Bladder injury is more common during

hysterectomy
 About ureteral injury, thermal injury is the

main cause
Nerve injury
 Transient nerve injury may occur due to
incorrect positioning
 Affecting brachial plexus, common peroneal

nerve and saphenous nerve

Saphenous nerve Common peroneal nerve
THANK YOU