Section III. ABDOMINAL GYNECOLOGICAL AND OBSTETRICAL SURGERY
2-35. LAPAROSCOPY (PERITONEOSCOPY, CELIOSCOPY)
a. General. This procedure involves the endoscopic visualization of the
peritoneal cavity through the anterior abdominal wall after the establishment of a
pneumoperitoneum. It provides the gynecologist the same anatomical view of the pelvic
organs as is seen at the diagnostic laparotomy. The pathological condition can be
seen, the ancillary procedures such as aspiration of cysts, tubal plastics, and tissue
biopsies can be performed. Hemostasis can readily be obtained by using the active
electrode probe. This procedure may enable the surgeon to avoid unnecessary pelvic
b. Preparation of Patient. The patient is placed in the supine position, given
general anesthetic, and skin prepped as for a laparotomy. A Foley catheter is inserted,
and the table is placed in extreme Trendelenburg position with shoulder braces correctly
c. Operative Procedure.
A 1-cm incision is placed below or to the left of the umbilicus.
(2) The skin is elevated with hooks. The trocar and valve sleeve are
inserted first subcutaneously, then thrust boldly through the remaining layers of the
abdominal wall into the peritoneal cavity. The angle taken by the trocar is
approximately 45 toward the concavity of the pelvis.
(3) The trocar is removed, the valve sleeve closed, the rubber tubing from
the gas source attached, and a pneumoperitoneum produced. Care must be taken to
prevent overdistention of the abdomen.
(4) After the patient is placed in the Trendelenburg position, the laparoscope
is introduced and inspection begun. Should the biopsy or cautery forceps be needed,
they are introduced by trocar through a separate small incision in the abdomen.
(5) The scopes are withdrawn; gas is allowed to escape from the sleeve
before it is withdrawn. Subcuticular closure of the skin is followed by the application of
a small dressing.
2-36. TOTAL ABDOMINAL HYSTERECTOMY
a. General. This operation involves the opening of the abdomen and the
peritoneal cavity, with removal of the entire uterus, including the corpus and the cervix.
It is done in the presence of fibroids (myomas) of the uterus resulting in uncontrollable
bleeding, degeneration, or in some cases, endometriosis or adenomyosis that is far
advanced. Total hysterectomy is also indicated in older women with endometriosis