Lap

1. laparoscopy
BY
Amr Othman Abdel-Kareem
Ass. Lec. OB/GYN
Sohag Faculty of Medicine

2. • Laparoscopy (from Ancient Greek (lapara),
meaning "flank, side", and (skopeó), meaning
"to see").
• It is an operation performed in the abdomen
or pelvis through small incisions(usually 0.5–
1.5 cm) with the aid of a camera. It can either
be used to inspect and diagnose a condition or
to perform surgery.

3. Indications
A. Diagnostic indications:
1. Infertility: abnormal HSG or after 3-6 months of
normal HSG.
2. Diagnosis of pelvic endometriosis.
3. In cases of chronic pelvic pain.
4. In some cases with primary amenorrhea.
5. Diagnosis of adnexal mass.
6. Diagnosis of ectopic pregnancy.
7. Evaluation of uterine perforation.
8. Second look laparoscopy after surgery for malignant
ovarian tumors.

4. Indications
B. Therapeutic indications:
Nearly most of the types of gynecological surgeries
can be performed laparoscopically.
1. Adhesolysis.
2. Fulguration or excision of endometriotic tissue.
3. Tubal sterilization.
4. Ovarian cystectomy.
5. Ovarian drilling.
6. Oopherectomy.

5. 7. Adnexectomy.
8. Salpingectomy, salpingostomy.
9. Myomectomy.
10. Hysterectomy.
11. Isthmopexy( ventral suspension).
12. Removal of missed IUD.
13. Presacral neurectomy .
14. LUNA ( laparoscopic uterine nerve ablation ).
15. GIFT.

6. Contraindications
• Absolute contraindications:
– Coagulation disorder.
– When pnemoperitoneum is contraindicated:
• Diaphragmatic hernia.
– When there is risk of visceral injury.
• Peritonitis.
• Paralytic ileus.
• Intestinal obstruction.
• Large amount of hemoperitonium
• Huge masses.
• Advanced pregnancy.

7. • Relative contraindications:
– Marked obesity.
– Severe cardiac or pulmonary disease.
– Previous extensive abdominal surgeries.
– Previous bowel surgery.

8. Laparoscopy set

20. Timing of the procedure
• According to the type of the procedure
• In cases of infertility and elective surgery
usually done post menstrual.

21. Complications
1. Anasthesia complications.
2. Perforation of the uterus.
3. Failed insufflation.(extraperitoneal insufflation
of gas).
4. Emphysema of the abdominal wall.
5. Gas embolism.
6. Failed trocar insertion.
7. Vascular injury:
– Parital : inferior epigastic
– Major: IVC, Aorta, Int. iliac…..

22. 8. Visceral injury.
9. Diathermy burn:
– Abdominal wall
– Intestine
– Ureter
10.Cardiac embarrassment.
11.Post operative:
– Hernia
– Infection
– Secondary hemorrhage