Microlaparoscopic Surgery

Microlaparoscopy may be the newest minimally invasive surgical technique that revolutionizes diagnostic laparoscopy. Just as rapid advances in electronics have shrunk computers to some fraction of their original size, similar advances in surgical instrumentation offer new opportunities to diagnose and treat surgical disease.

While a typical laparoscope is about 10-12mm in dimensions, (slightly less than 1/2 inch) recently developed microlaparoscopes are less than 3mm (slightly more than 1/10th of an inch). While previously small incisions were made within the belly-button, now, certain surgical treatments can be performed with only a needle stick. I will place small scissors, graspers, biopsy instruments or a laser fiber through one or two additional 3mm needles.

This enables me to do diagnostic laparoscopy or simple surgical treatments using a local anesthetic and sedation through an intravenous catheter. This means a smaller amount incisional pain after your surgery. Additionally, it means less anesthetic, no sore throat, and less nausea. In many cases you might be able to resume all normal activities in a few hours.

Frequently, laparoscopy can be used to insure that the fallopian tubes are normal there aren't any factors adding to infertility. Unfortunately, sometimes I'll find a problem that cannot be corrected with microlaparoscopy. For those who have significant adhesions, endometriosis or other abnormalities, you'll receive a general anesthetic and the operation is finished using standard laparoscopic techniques.

Pain mapping is yet another useful microlaparoscopic technique. If you suffer from from chronic pain and previous surgical procedures have not localized the cause, a microlaparoscopic procedure may supply the answer. A microlaparoscopic diagnostic procedure is performed when you are sedated, but nonetheless awake. I will use a probe to carefully touch various structures like the uterosacral ligaments, the ovaries, tubes, uterus, bladder or an adhesion to see if that area duplicates your pain. If the supply of your pain is situated, surgery may be more effective at providing relief.

Microlaparoscopy is within its infancy. Its' primary uses are for diagnostic surgery. But, as new instruments become available our capabilities increases. I am very excited to offer my patients microlaparoscopy and truly believe this technique will simplify and lower the price of diagnosing the cause of pelvic pain and infertility.

In the turn from the twentieth century, crude techniques and instrumentation made laparoscopic evaluation cumbersome and challenging to the clinician. Primitive laparoscopes with inferior lighting and image transmission, poor anesthetic methods, and untested laparoscopic techniques produced limited useful data. During the past quarter century, tremendous advances in laparoscopy have been achieved in both gynecologic and general surgery.

Minimally invasive microlaparoscopic surgery continues to reinvent and redefine contemporary medicine as laparoendoscopic surgeons invade the 21st century. The availability of this technology in operative medicine will force surgeons to perform procedures inside a more non-invasive and cost-effective manner. Myriad technique and instrumentation modifications mark the developments which have led to microlaparoscopy. The advances in microlaparoscopy noted today have come to light primarily from continued progress in fiberoptic technology.

Microlaparoscopy uses small-caliber laparoscopes, 2 mm or less in diameter, made from microfiber-optic bundles measured in micrometers. The present 2-mm microlaparoscopes possess a 50000-fiber image pack that produces enhanced resolution along with a 75° field of view, similar to a typical 10-mm rod lens laparoscope.

As well as the microlaparoscopes, laparoscopic instruments have similarly been miniaturized. Included in this are 2-mm trocars that can be mounted on a Veress needle prior to creating the pneumoperitoneum. Once the pneumoperitoneum is achieved, the Veress needle is taken away leaving the 2-mm trocar in position. This precludes the necessity of a “second-pass” trocar placement and allows the immediate insertion of the microlaparoscope. Open laparoscopy was introduced to reduce the risk of blind entry to the peritoneal cavity.

Today the availability of microlaparoscopy makes open laparoscopy obsolete. Problems for the bowel with open laparoscopy has been reported to happen at the same rate as that with blind entry utilizing a 2-mm cannula. In cases of suspected bowel perforation, the diagnosis can be immediately confirmed without producing further harm to the bowel. Bowel perforations caused by 2-mm instrumentation could be managed conservatively without suturing, provided the website of damage isn't actively leaking stool or bleeding.

In gynecologic surgery, microlaparoscopy was used for that examination and treating patients with chronic pelvic pain, endometriosis, pelvic adhesions, ovarian cysts, pelvic inflammatory disease, in addition to both infertility and undesired fertility. Patients with an ectopic pregnancy who desire medical therapy with methotrexate will occasionally experience pain due to necrosis of the villi. On this situation, the pain is difficult to differentiate from rupture of the tubal pregnancy.

Microlaparoscopy with the patient under local anesthesia may be used to get yourself a rapid diagnosis during these circumstances and perhaps prevent an unnecessary procedure using general anesthesia. Women with polycystic ovarian syndrome who are resistant to medical treatment, those for whom medical therapy may be cost-prohibitive, and those who have concerns about multiple gestations may benefit from microlaparoscopic ovarian drilling

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