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Fallopian Tubes
and Ovaries

Laparoscopy Technique

Diagnostic Uses
of Laparoscopy

Demonstration
of Tubal Patency
via Laparoscopy

Laparoscopic Resection
of Unruptured
Ectopic Pregnancy

Ovarian Biopsy
via Laparoscopy

Electrocoagulation of
Endometriosis via
Laparoscopy

Lysis or Adhesions
via Laparoscopy

Control of Hemorrhage
During Laparoscopy

Fallopian Tube
Sterilization

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

Salpingectomy

Salpingo-oophorectomy

Fimbrioplasy

Tuboplasty -
Microresection
and Anastomosis
of the Fallopian Tube

Wedge Resection
of the Ovary

Torsion of the Ovary

Ovarian Cystectomy

Demonstration of Tubal Patency
via Laparoscopy

Modern infertility evaluations are rarely complete without observation of the Fallopian tube and ovary for disease. Laparoscopy has replaced culdoscopy as the procedure of choice because it allows the pelvic surgeon a broader plane of observation, better manipulation of internal structures, and the ability to electrocoagulate endometrial implants.

The purpose of the operation is to inject a dye through the uterus and the Fallopian tube to demonstrate patency of the tube.

Physiologic Changes. None.

Points of Caution. Care must be taken to ensure that there is a watertight seal between the acorn on the cervical cannula and the surface of the cervix to prevent the dye from leaking back into the vagina.

Technique

As with all laparoscopic diagnostic procedures, a Rubin cannual and Jacobs tenaculum are applied to the cervix prior to beginning the procedure. The patient is positioned with the buttocks at least 4 inches off the end of the operating table. This is essential if the surgeon is to have proper observation while injecting indigo carmine solution through the endometrial cavity into the Fallopian tubes.

Laparoscopy is performed in the routine fashion. Generally, the one-incision technique is sufficient for adequately observing the entire pelvis. The Fallopian tubes should be grasped with a smooth 3-mm forceps and maneuvered into a position where they can be adequately observed.

Ten mL of indigo carmine solution are injected through the Rubin cannula in the cervix. The solution can be observed flowing from the Fallopian tube, or the point of obstruction can be noted. It is not necessary to remove the indigo carmine from the abdomen. The instruments are withdrawn, and the laparoscopy incision is closed in a routine fashion.

 

 

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