Introduction to

Gynecology Endoscopy
and Operating Room Setting
 OBJECTIVES

At the end of this chapter you will be

able to:

1. Describe the principles of endoscopy in

gynecology
2. Describe the advantages of endoscopic
surgery in gynecology
3. Know how to set operating room for
endoscopic surgery
 MINIMALLY INVASIVE
SURGERY
 An approach to surgery whereby operations
are performed with specialized instruments
designed to be inserted through small
incisions or natural body openings
 DEFINITION

Minimally invasive surgery (MIS)

Gynecology
endoscopy
 LAPAROSCOPY

 Laparoscopy is the inspection of the

peritoneal cavity by means of a telescope
introduced through the abdominal wall after
creation pneumoperitoneum
 INDICATIONS

1. Diagnostic laparoscopy
2. Tubal sterilization
3. Adhesiolysis
4. Endometriosis + cystectomy
5. Ectopic pregnancy
6. Oophorectomy
7. Miomectomy
8. Hysterectomy
9. Oncologic procedures
 INDICATIONS

1. Diagnostic laparoscopy
2. Tubal sterilization
3. Adhesiolysis
4. Endometriosis + cystectomy
5. Ectopic pregnancy
6. Oophorectomy
7. Miomectomy
8. Hysterectomy
9. Oncologic procedures
 ADVANTAGES

1. Improved diagnosis
2. Less tissue dissection & disruption
3. Less wound infection
4. Less chance of adhesions
5. Early return to work
6. Less pain postoperatively
 DISADVANTAGES

1. More expensive
2. More operative time
3. Potential for major
complications in
inexperienced hands
4. Difficult in complicated
cases
 CONTRA INDICATIONS

1. Severe COPD or cardiac disease

2. Grade II or III schock
3. Previous extensive abdominal surgery
4. Suspected carcinoma
 GENERAL ROOM SETUP

 Two monitors would

be available with one
to each side of the
legs
 Requires an
operating table that
can be placed in deep
Trendelenburg
position
PATIENT’S POSITION
 UTERINE MOBILIZATION

 Good uterine
manipulator
should be
capable of
anteverting and
positioning the
uterus
FUTURE DEVELOPMENT

NOW FUTURE
 CONCLUSIONS

1. Laparoscopy is one of MIS proceedure

which is possible to be performed as a
diagnostic and therapeutic tools in
gynecology disorders
2. Many advantages of laparoscopic
procedures has made it become the first
choice in gynecologic surgery
3. Setting operating theatre is quite
important not only for the surgery but
also in preventing complications
THANK YOU
 HISTORY

No Name Year Surgery

1 George Kelling 1900 Laparoscopic surgery performed in dog
2 HC Jacobus 1910 First laparoscopic procedures in human
3 Janos Veres 1920 Developed veres needle
4 Kurt Semm 1960 Developed insufflator
5 Erich Muhe 1985 First laparoscopic cholecystectomy
6 Ger 1987 First laparoscopic repair of inguinal
hernia
7 Reich et al 1989 First laparoscopic hysterectomy
8 Dan Stoianovici 1993 First robotic laparoscopic surgery
MINIMALLY INVASIVE SURGERY
(MIS)

No Name

1 Key hole surgery

2 Endoscopic surgery
3 Button hole surgery
4 Minimally invasive surgery (MIS)
Minimally access surgery (MAS)
- Laparoscopy
5 - Cystoscopy
- Hysteroscopy
- Thoracoscopy
 GENERAL ROOM SETUP

Since operative endoscopy is completely

dependent on high tech equipment,
all should be thoroughly checked
prior to the start of each case
 FREQUENTLY MINIMALLY INVASIVE
SURGERY PROCEDURES

Abdomen Chest Urology Gynecology Others

Esophagectomy Mediastinoscopy Nephrectomy Ovaries Thyroid

Hernia Thymus Adrenalectomy Uterus Mastectomy

Appendectomy Lung resection Stone disease Infertility Robotics

Cholecystectomy Lung biopsy Varicocele Ectopic

Splenectomy Pleural lesions Adhesion

 GYNECOLOGY LAPAROSCOPY

 has evolved from a limited surgical

procedure used only for diagnosis and
tubal ligations to a major surgical tool
 Hybrid surgical approach
 Laparoscopic procedures have unique
risks, related to methods used for the
placement of abdominal wall ports and to
the pneumoperitoneum, and the use of
energy