LAPAROSCOPIC SURGICAL TREATMENT FOR INFERTILITY

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USSIA A.; KONINCKX PH.R.

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Journal Paper

Paper Information

Journal: CELL JOURNAL (YAKHTEH) Year:2008 | Volume:10 | Issue:SUPPLEMENT 1 Page(s): 26-27

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Title

LAPAROSCOPIC SURGICAL TREATMENT FOR INFERTILITY

Author(s)

USSIA A. | KONINCKX PH.R.

Keywords

ENDOMETRIOSIS CAN PRESENT AS SUBTLE LESIONS

TYPICAL LESIONS

CYSTIC OVARIAN ENDOMETRIOSIS AND DEEP ENDOMETRIOSIS

Abstract

Before detailing the possibilities of laparoscopic surgical treatment a clear understanding of the energy modalities is required, ie electrosurgery, CO2 laser and harmonic scalpel. Secondly, especially in infertility, the ‘see and treat’ principle is important, ie during the diagnostic laparoscopy almost all surgical treatment should be feasible. Finally the relative advantages and disadvantages, of performing systematically a diagnostic laparoscopy early during infertility investigation, should be considered. We will not discuss the pro and con’s of performing systematically a laparoscopy or instead a THL in those women without suspicion of pathology.The preoperative work-up aims at identifying those women who need a bowel preparation and those women who need a ureter stent. When a deep nodule is suspected, clinically or by ultrasound, therefore a contrast enema and IVP are mandatory and a bowel preparation should be given. We also favor to give a bowel preparation for women who have been operated several times beforehand. During laparoscopic surgery any pathology will be treated. This varies from the treatment of the various forms endometriosis, to adhaesiolysis, myomectomy, salpingostomy and ovarian drilling. Endometriosis has already been discussed. Adhaesiolysis and adhaesion reformation is a controversial topic, for which none of the available antiadhaesive treatments has been validated. Yet today we expect that soon effective treatments will become available through additional pneumoperitoneum conditions ie adding small amounts of oxygen and cooling. The relationship between myoma’s and infertility is unclear. It is widely accepted however that submucoal myoma’s should be removed by hysteroscopy, and that the larger subserous or pedunculated myoma’s can cause mechanical infertility.Salpingostomy is the treatment of choice for hydrosalpinges with cumulative pregnancy rates around 60%. In women with thickwalled hydrosalpinges or with absence of mucosal folds at salpingoscopy of in case of tuberculosis, a salpingectomy should be performed. Ovarian drilling restores ovulation in some 80% of PCO women. Only 50% get pregnant and the drilling associated adhesions and infertility remains a topic of debate. Recently, drilling by THL has been introduced and initial data suggest that after ‘underwater’ drilling adhaesions are virtually absent . Finally surgery should be balanced with the IVF. Today however, surgery still is the method of choice provided performed adequately

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APA: Copy

USSIA, A., & KONINCKX, PH.R.. (2008). LAPAROSCOPIC SURGICAL TREATMENT FOR INFERTILITY. CELL JOURNAL (YAKHTEH), 10(SUPPLEMENT 1), 26-27. SID. https://sid.ir/paper/544083/en

Vancouver: Copy

USSIA A., KONINCKX PH.R.. LAPAROSCOPIC SURGICAL TREATMENT FOR INFERTILITY. CELL JOURNAL (YAKHTEH)[Internet]. 2008;10(SUPPLEMENT 1):26-27. Available from: https://sid.ir/paper/544083/en

IEEE: Copy

A. USSIA, and PH.R. KONINCKX, “LAPAROSCOPIC SURGICAL TREATMENT FOR INFERTILITY,” CELL JOURNAL (YAKHTEH), vol. 10, no. SUPPLEMENT 1, pp. 26–27, 2008, [Online]. Available: https://sid.ir/paper/544083/en

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