Explain: Laparoscopy Electrocautry of Endometriosis
Content:
Clinical information:
The female patient had the chief complaint of [[infertility,
dysmenorrhea,lower abdominal pain, suspicious endometiosis/endometrioma]].
Pelvic examination revealed [[no specific finding, cul-de-cac nodularity,
frozen pelvis, adnexal mass]]. Ultrasonography showed [[no specific finding,
adnexa tumor]], endometriosis was suspected. Operative laparoscopy with
{{direct electrocautry, CO2 laser vaporization}} was planned.
Operative Findings:
AFS classification of endometriosis Additional Endometriosis
Stage I (Minimal) 1-5
_________________________ _______________________________
Stage II (Mild)
6-15
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_______________________________
Stage III (Moderate) 16-40
_________________________
_______________________________
Stage IV (Severe) >40
_________________________
_______________________________
Total: _________________________
|
|
ENDOMETERIOSIS |
<1cm |
1-3
cm |
>3
cm |
|
|
Peritoneum |
Superficial |
1 |
2 |
4 |
|
|
|
Deep |
2 |
4 |
6 |
|
|
|
R Superficial |
1 |
2 |
4 |
|
|
|
Deep |
4 |
16 |
20 |
|
|
OVARY |
L Superficial |
1 |
2 |
4 |
|
|
|
Deep |
4 |
16 |
20 |
|
|
|
POSTERIOR CULDESAC |
Partial |
|
Complete |
|
|
|
OBLITERATION |
4 |
|
40 |
|
|
|
DHESIONS |
<1/3
Enclosure |
1/3-2/3
Enclosure |
>
2/3 Enclosure |
|
|
|
R Filmy |
1 |
2 |
4 |
|
|
OVARY |
Dense |
4 |
8 |
16 |
|
|
|
L Filmy |
1 |
2 |
4 |
|
|
|
Dense |
4 |
8 |
16 |
|
|
|
R Filmy |
1 |
2 |
4 |
|
|
|
Dense |
4* |
8* |
16 |
|
|
TUBE |
L Filmy |
1 |
2 |
4 |
|
|
|
Dense |
4* |
8* |
16 |
|
* If the fimbriate end
of the fallopian tube is completely enclosed, charge the point assignment to
16.
Operative Procedures:
The woman was brought
to the operating room and placed in the dorsolithotomy Trendelenburg position.
General anesthesia was performed through endotracheal intubation. The abdominal
wall was sterilized with soap solution and alcohol betadine and the vagina and
cervix with aqua betadine.A uterine manipulator was inserted into the uterus
for its manipulation. Once adequate preumoperitoneum was obtained, a 10 mm
laparoscopic was inserted through a peri-umbilical incision, and two 5 mm
puncture sites were made in the lower abdomen at the para-median line. The
intestine loop was placed up to the abdominal cavity and the uterus and adnexa
were exposed.
Adnexal endometrioma was noted, fixed in ovarian fossa. Ovarian
endometrioma was enucleated, bilateral tubes were patent,. Cul-de-sac was parial obstructed, endometriosis was
evaporized by electro cauterization or laser.After complete haemostasis and
irrigation, drainage was set up. The abdominal wall laparoscope wound was approrimately
by 3-0 vicryl.