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Fallopian Tubes
and Ovaries

Laparoscopy Technique

Diagnostic Uses
of Laparoscopy

of Tubal Patency
via Laparoscopy

Laparoscopic Resection
of Unruptured
Ectopic Pregnancy

Ovarian Biopsy
via Laparoscopy

Electrocoagulation of
Endometriosis via

Lysis or Adhesions
via Laparoscopy

Control of Hemorrhage
During Laparoscopy

Fallopian Tube

Sterilization by
Electrocoagulation and
Division via Laparoscopy

Silastic Band Sterilization
via Laparoscopy

Hulka Clip Sterilization
via Laparoscopy

Sterilization by the
Pomeroy Operation

Sterilization by the
Modified Irving Technique

Sterilization by the
Minilaparotomy Technique

Sterilization - Ucheda Technique




Tuboplasty -
and Anastomosis
of the Fallopian Tube

Wedge Resection
of the Ovary

Torsion of the Ovary

Ovarian Cystectomy

Diagnostic Uses of Laparoscopy

Laparoscopy offers the pelvic surgeon a significant advantage by providing accurate diagnostic techniques without requiring exploratory laparotomy. It is particularly useful in (1) identifying unique and unusual alterations in pelvic anatomy, (2) resolving questions about an ectopic pregnancy that is difficult to diagnose. (3) differentiating between borderline and severe cases of pelvic inflammatory disease and between pelvic disease and acute appendicitis, and (4) evaluating the pelvis and Fallopian tubes in cases of infertility.

The purpose of the operation is to visualize the lower abdomen and pelvis without performing a laparotomy.

Physiologic Changes.  None.

Points of Caution. Laparoscopy should not be used diagnostically where there is overwhelming evidence of pelvic disease requiring exploratory laparotomy. For example, it is unwise and contraindicated to perform diagnostic laparoscopy where there are pelvic masses greater than 14 weeks gestation size. In these cases, exploratory laparotomy should be performed. Likewise, diagnostic laparoscopy should not be performed with a gross hemoperitoneum or generalized abdominal peritonitis. Performance of laparoscopy is not excessively hazardous under these conditions, but it adds nothing to the overall diagnosis and simply delays exploratory laparotomy.


An alteration in pelvic anatomy that may be associated with a congenital anomaly of the Mullerian duct is shown. In institutions with adequate cytogenic laboratories, diagnostic laparoscopy is not required for anomalies of the internal genitalia because in most cases the anomaly can be diagnosed without operative intervention. In cases of failure in Mullerian duct fusion in which there is a rudimentary or smaller separate horn on one side and an enlarged horn on the opposite side, however, the use of the laparoscope may be valuable in developing a complete treatment plan.

Women with amenorrhea, abdominal pain, vaginal bleeding, and/or an adnexal mass do not need diagnostic laparoscopy to rule out the possibility of ectopic pregnancy. However, many women with ectopic pregnancy have vague symptoms and ambiguous signs. Even if a culdocentesis shows a small amount of nonclotting blood, the laparoscope is a valuable instrument in differentiating a tubular pregnancy from a bleeding corpus luteum cyst. In addition, the bleeding corpus luteum can be electrocoagulated through the laparoscope, and laparotomy may be avoided. If there is gross abdominal distention from a hemoperitoneum, however, laparoscopy only delays appropriate therapy.

Frequently, the surgeon is not able to see the dilated Fallopian tube containing the pregnancy as shown here. Often, a cornual mass is visible, consisting of clotted blood mixed with tissue.

Diagnostic laparoscopy has been of great assistance in differentiating between the difficult cases of pelvic inflammatory disease and acute appendicitis. The treatment for each is quite different, and if an accurate preoperative diagnosis can be made, substantial savings in hospital costs and utilization of hospital beds can be made. In addition, purulent material can be aspirated through the laparoscope to ascertain the exact etiology of the endosalpingitis and aid in selection of appropriate antibiotic therapy. When there are signs and symptoms of generalized peritonitis, however, laparoscopy is contraindicated and only delays the exploratory laparotomy needed to correct the problem.


Copyright - all rights reserved / Clifford R. Wheeless, Jr., M.D. and Marcella L. Roenneburg, M.D.
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