Practical Manual of Operative Laparoscopyand

Hysteroscopy

Second Edition

Springer Science+Business Media, LLC

Ricardo Azziz Professor; Department of

Obstetrics and Gynecology University of Alabama

School of Medicine Birmingham, Alabama

Ana Alvarez Murphy Director; Division of

&productive Endocrinology Department of Obstetrics and Gynecology Emory University School of Medicine Atlanta, Georgia

Editors

Practical Manual of Operative Laparoscopy and

Hysteroscopy Second Edition

Illustrated 1Yy Rod Powers and Josephine Taylor

With 200 figures in 269 parts

Springer

Ricardo Azziz, M.D., M.P.H. Professor, Departtnent of Obstetrics

and Gynecology University of A1abama School of

Medicine 618 South 20th St. Birmingham, AL 35233-7333, USA

Library of Congress Cataloging in Publication Data

Ana A1varez Murphy, M.D. Director, Division of Reproductive

Endocrinology Departtnent of Obstetrics and Gynecology Emory University School of Medicine 1639 Pierce Drive AtIanta, GA 30322, USA

Practical manual of operative laparoscopy and hysteroscopy / [edited by] Ricardo Azziz, Ana Alvarez Murphy. - 2nd ed.

p. cm. Includes bibliographical references and index. ISBN 978-1-4612-7324-0 ISBN 978-1-4612-1886-9 (eBook) DOI 10.1007/978-1-4612-1886-9 1. Generative organs, Female-Endoscopic surgery. I. Azziz,

Ricardo. II. Murphy, Ana Alvarez. [DNLM: 1. Genital Diseases, Female-Surgery. 2. Laparoscopy-

methods. 3. Hysteroscopy-methods. WP 660 B895 1996] RG104.7.P73 1996 618.1'059-dc20 DNLM/DLC 96-21229 for Library of Congress

Printed on acid-free paper.

© 1992, 1997 Springer Science+Business Media New York Originally published by Springer-Verlag New York, lnc.in 1992,1997 Softcover reprint of the hardcover 2nd edition 1997 Ali rights reserved. This work may not be translated or copied in whole or in patt without the written permission of the publisher (Springer Science+ Business Media, tiC ), except for brief excerpts in connection with reviews or scholarly ana!ysis. U se in connection with any form of information storage and retrieva!, electronic adaptation, computer software, or by similar or dissintilar methodology now known or hereafter developed is forbidden. The use of genera! descriptive names, trade names, trademarks, etc., in this publication, even if the former ate not especially identified, is not to be taken as a sign that such names, as understood by the T rade Marks and Merchandise Matks Act, may accordingIy be used freely by anyone. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any lega! responsibility for any etrors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the materia! contained herein.

Production coordinated by Impressions Book andJournal Services, lnc. and managed by Terry Kornak; manufacturing supervised by Jeffrey Taub.

Typeset by Impressions Book andJournal Services, Inc., Madison, WI.

987654321

ISBN 978-1-4612-7324-0

To our families for their love and support, and in memoriam of IWd Powers, a wonderful friend and artist

Foreword to the First Edition

In the past decade, the future of gynecologic endoscopic surgery has been largely unpredictable. Now it is obvious that time has changed gynecology in such a way as to make many of the procedures that were commonly done obsolete. At no other time in the history of gynecologic surgery has such an explosion occurred, thus changing the face of this specialty to such a great degree. But in addition to solving many problems, the past decade has left us with many new and novel dilemmas.

One of the ways in which our field has tremendously evolved is that not only have some procedures become obsolete, but also to some degree gynecologic surgeons have themselves become obsolete. I write this because those not trained in the new techniques have had to go back and learn these surgical procedures in an uncon­ventional way. This "unconventional way" is attending courses, and being super­vised and preceptored by members of one's own hospital staff, then finally trans­mitted into granting of privileges. It is the young who are the leaders and, paradoxically, bringing experience to the field. In many instances, I have seen the resident who is a better endoscopic surgeon than the Senior Attending.

Not only have new techniques and operations been introduced, such as the use of the resectoscope and electrocautery to remove intrauterine myomas, but a new technology has also arisen. Mastery is imperative. One cannot master these tech­niques by mimicking what other surgeons do, but must understand the principles of the technological advances. Laser physics and properties must be understood and, in addition, optics and television technology are critical to performing excel­lent endoscopic surgery.

Old timers are playing catch-up ball, but it is the young who are the leaders and pioneers in our field. It is for this reason that this text represents all that is impor­tant in endoscopic surgery. It not only is a comprehensive and encyclopedic disser­tation on the subject, but it is written by the young leaders in the field. This is a textbook that will go through many editions, passed on from generation to genera­tion of endoscopic surgeons. Not only are the important subjects tackled (i.e., tech­niques) but also the important principles are covered: adhesion prevention, laser surgery, hemostasis, and instrumentation. Such difficult topics as cost-effective­ness, risk-benefit ratio, and need for randomized clinical studies are attacked with fervor to evaluate results properly.

vii

viii Foreword to the First Edition

This is an important text and destined to become a classic. It is comprehensive, principle oriented, and serves a real and tangible need.

I write this foreword with pride as an elder in the field.

Alan H. Decherney, M.D. Professor and Chair

Department of Obstetrics and Gynecology UCLA School of Medicine

Los Angeles, California

Acknowledgmen ts

We would like to thank our secretaries,1o Kirkpatrick and Esther Davidson, for their excellent assistance in the preparation of the manuscripts.

R. Azziz and A. Alvarez Murphy

ix

Contents

Foreword to the First Edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii ALAN H. DECHERNEY

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Introduction ..................................................... xix

JOHN A. ROCK

Part I: General Concepts in Operative Endoscopy . . . . . . . . . 1

1 History of the Development of Gynecologic Endoscopic Surgery 3 MARIAN D. DAMEWOOD

2 Training, Certification, and Credentialing in Gynecologic Operative Endoscopy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

RICARDO AzZIZ

3 Developing a Training Program in Operative Endoscopy MICHAEL]' SAMMARCO

4 Principles of Endoscopic Optics and Lighting RICHARD P. BUYALOS

16

23

5 Electrosurgery and Thermocoagulation at Operative Endoscopy. . . . . . . 32 RICARDO AzZIZ

6 Principles of Endoscopic Laser Surgery RICHARD P. BUYALOS

40

7 Photo and Video Documentation in Endoscopic Surgery . . . . . . . . . . . . . 49 ERIC S. KNOCHENHAUER and RICARDO AzZIZ

Part II: Operative Laparoscopic Procedures 59

8 Technique and Instrumentation in Operative Laparoscopy ........... 61 SUJATHA REDDY, ARLENE MORALES, and ANA ALVAREZ MURPHY

xi

xii Contents

9 Sutures, Clips, and Staples ...................................... 77 ANA ALVAREZ MURPHY and SUJATHA REDDY

10 Laparoscopic Anatomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 87 WILLIAMW. HURD andJEAN A. HURTEAU

11 Principles of Laparoscopic Microsurgery and Adhesion Prevention. . . .. 94 JACQUELINE N. GUTMANN and MICHAEL P. DIAMOND

12 Contemporary Management of Ectopic Pregnancies. . . . . . . . . . . . . . . .. 108 ANA ALVAREZ MURPHY and SUJATHA REDDY

13 Laparoscopic Tubal Surgery and Adhesiolysis JOHN S. HESLA andJOHN A. ROCK

120

14 Laparoscopic Tubal Anastomosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 133 EUGENE KATZ

15 Laparoscopic Treatment of Endometriosis. . . . . . . . . . . . . . . . . . . . . . . .. 137 DAN C. MARTIN

16 Laparoscopic Ovarian and Parovarian Surgery . . . . . . . . . . . . . . . . . . . . .. 147 MICHAEL P. STEINKAMPF and RICARDO AzZIZ

17 Laparoscopic Myomectomy ..................................... 163 BRADLEY S. HURST

18 Laparoscopic Uterine Nerve Ablation, Presacral Neurectomy, and Uterovaginal Ganglion Excision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 173

C. PAUL PERRY

19 Laparoscopic Treatment of Tubo-ovarian and Pelvic Abscess .......... 181 HARRY REICH

20 Laparoscopic Suspension Procedures ............................. 187

21

CAMRAN NEZHAT, FARR NEZHAT, and CEANA H. NEZHAT

Laparoscopic Hysterectomy HARRY REICH

194

22 Laparoscopic Retropubic Col po suspension Procedures .............. 209 ANDREW 1. BRILL

23 Laparoscopic Intestinal Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 224 DANIEL S. SEIDMAN, FARR NEZHAT, CEANA H. NEZHAT, and CAMRAN NEZHAT

24 Office Laparoscopy Under Local Anesthesia ....................... 239 STEVEN F. PALTER

Contents xiii

25 Minimizing, Recognizing, and Managing Laparoscopic Complications 248 SAMUEL SMITH

Part III: Operative Hysteroscopic Procedures. . . . . . . . . .. 271

26 General Techniques and Instrumentation of Operative Hysteroscopy . .. 273 YOLANDA R. SMITH, DENISE MURRAY, and HOWARD A. ZACUR

27 Operative Hysteroscopic Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 286 ERIC S. KROCHENHAUER and RICHARD E. BLACKWELL

28 Hysteroscopic Myomectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 294 STEFANIE SCHUPP CHRISTIAN and WILLIAM D. SCHLAFF

29 Endometrial Ablation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 301 JAMES F. DANIELL

30 Hysteroscopic Treatmen t of Congenital Uterine Anomalies .. . . . . . . . .. 313 SCOTT M. SLAYDEN and J. BENJAMIN YOUNGER

31 Transcervical Tubal Cannulation, Tuboplasty, and Fal\oposcopy ....... 322 EUGENE KATZ

32 Minimizing, Recognizing, and Managing Hysteroscopic Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 330

SAMUEL SMITH

Index ........................................................... 337

Contributors

RICARDO AzZIZ, M.D., M.P.H. Division of Reproductive Biology and Endocrinology, Department of Obstetrics and Gynecology, The University of Alabama at Birmingham School of Medicine, 619 South 20th Street, Birmingham, Al35233-7333, USA

RICHARD E. BLACKWELL, PH.D., M.D. Division of Reproductive Biology and Endocrinology, Department of Obstetrics and Gynecology, The University of Alabama at Birmingham School of Medicine, 619 South 20th Street, Birmingham, Al35233-7333, USA

ANDREW 1. BRILL, M.D. Department of Obstetrics and Gynecology, The University of Chicago, 820 South Wood Street, Chicago, IL 60612-7313, USA

RICHARD P. BUYALos, M.D. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Kentucky School of Medicine, 800 Rose Street, Lex­ington, KY 40536-0084, USA

MARlAN D. DAMEWOOD, M.D. Greater Baltimore Medical Center, Women's Resource Center, 6569 North Charles Street, Suite 406, Baltimore, MD 21117; and Department of Gynecology and Ob­stetrics, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21205, USA

JAMES F. DANIELL, M.D. Women's Health Group, 2222 State Street, Suite A, Nashville, TN 37202, USA

MICHAEL P. DIAMOND, M.D. Division of Reproductive Endocrinology, Department of Obstetrics and Gynecol­ogy, Hutzel Hospital/Wayne State University School of Medicine, 4707 St. Antoine Blvd., Detroit, MI 48201, USA

xv

xvi

JACQUELINE N. GUTMANN, M.D. Department of Obstetrics and Gynecology, ThomasJefferson University School of Medicine, 1025 Walnut Street, Philadelphia, PA 19107; and Philadelphia Fertility Institute, 815 Locust Street, Philadelphia, PA 19107, USA

JOHN S. HESLA, M.D. The Center for Reproductive Medicine, 799 E. Hampden Avenue, Suite 300, Engle­wood, CO 80110, USA

WILLIAM W. HURD, M.D. Division of Reproductive Endocrinology, Department of Obstetrics and Gynecol­ogy, Indiana University School of Medicine, 550 University Boulevard, Indianapo­lis, IN 46202, USA

BRADLEY S. HURST, M.D. Division of Reproductive Endocrinology, Department of Obstetrics and Gynecol­ogy, University of Colorado Health Sciences Center, 4200 East 9th Avenue, Box B198, Denver, CO 80262, USA

JEAN A. HURTEAU, M.D. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Indi­ana University School of Medicine, 550 University Boulevard, Indianapolis, IN 46202, USA

EUGENE KATZ, M.D. Greater Baltimore Medical Center, Women's Hospital Fertility Center, 6569 North Charles Street, Suite 406, Baltimore, MD 21117, USA

ERIC S. KNOCHENHAUER, M.D. Division of Reproductive Biology and Endocrinology, Department of Obstetrics and Gynecology, The University of Alabama at Birmingham School of Medicine, 619 South 20th Street, Birmingham, AL 35233-7333, USA

DAN C. MARTIN, M.D. Department of Obstetrics and Gynecology, University of Tennessee, Memphis, TN 38103; and Reproductive Surgery, 1717 Kirby Parkway, Suite 100, Memphis, TN 38120, USA

ARLENE MORALES, M.D. Department of Reproductive Medicine, University of California at San Diego, 9500 Gilman Drive, BSB 5046B, La Jolla, CA, 92093-0633, USA

ANA ALVAREZ MURPHY, M.D. Division of Reproductive Endocrinology, Department of Gynecology and Obstet­rics, Emory University School of Medicine, 1639 Pierce Drive, Atlanta, GA 30322, USA

DENISE MURRAY, M.D. 9708 Medical Center Drive, Suite 230, Rockville, MD 20850, USA

Contributors

Contributors xvii

CAMRAN NEZHAT, M.D. Department of Surgery and Department of Gynecology and Obstetrics, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305; Center for Special Pelvic Surgery, 5555 Peachtree Dunwoody Road, Suite 276, Atlanta, GA 30342; and 900 Welch Road, Suite 403, Palo Alto, CA 94304, USA

CEANA H. NEZHAT, M.D. Department of Gynecology and Obstetrics, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305; and Center for Special Pelvic Surgery, 5555 Peachtree Dunwoody Road, Suite 276, Atlanta, GA 30342, USA

FARR NEZHAT, M.D. Department of Gynecology and Obstetrics, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305; and Center for Special Pelvic Surgery, 900 Welch Road, Suite 403, Palo Alto, CA 94304, USA

STEVEN F. PALTER, M.D. Yale Office Laparoscopy Program, Division of Reproductive Endocrinology, De­partment of Obstetrics and Gynecology, Yale University School of Medicine, 789 Howard Avenue, New Haven, CT 65210, USA

C. PAUL PERRY, M.D. 2006 Brookwood Medical Center Drive, Suite 402, Birmingham, AL 35209, USA

SUJATHA REDDY, M.D. Division of Reproductive Endocrinology, Department of Gynecology and Obstet­rics, Emory University School of Medicine, 875 Johnson Ferry Road NE, Atlanta, GA 30342, USA

HARRyREICH, M.D. Wyoming Valley GYNjOB Associates, 480 Pierce Drive, Kingston, PA 18704; and Department of Obstetrics and Gynecology, Center for Advanced Laparoscopic Surgery, Columbia University College of Physicians and Surgeons, 622 West 168th Street, New York, NY 10032, USA

JOHN A. ROCK, M.D. Division of Reproductive Endocrinology, Department of Gynecology and Obstet­rics, Emory University School of Medicine, 1639 Pierce Drive, Atlanta, GA 30322, USA

MICHAEL]' SAMMARCO, M.D. Department of Obstetrics and Gynecology, The University of Chicago, 820 South Wood Street, Chicago, IL 60612-7313, USA

WILLIAM D. SCHLAFF, M.D. Division of Reproductive Endocrinology, Department of Obstetrics and Gynecol­ogy, University of Colorado Health Sciences Center, Campus Box B-198, 4200 East Ninth Avenue, Denver, CO 80262, USA

xviii

STEFANIE SCHUPP CHRISTIAN, M.D. Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, Campus Box B-198, 4200 East Ninth Avenue, Denver, CO 80262, USA

DANIEL S. SEIDMAN, M.D. Department of Gynecology and Obstetrics, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA

SCOTI M. SlAYDEN, M.D. Division of Reproductive Biology and Endocrinology, Department of Obstetrics and Gynecology, The University of Alabama at Birmingham School of Medicine, 619 South 20th Street, Birmingham, AL 35233-7333, USA

SAMUEL SMITH, M.D. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Sinai Hospital Baltimore, 2411 W. Belvedere Avenue, Suite 206, Baltimore, MD 21215, USA

YOLANDA R. SMITH, M.D. Division of Reproductive Endocrinology, Department of Obstetrics and Gynecol­ogy, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA

MICHAEL P. STEINKAMPF, M.D. Department of Obstetrics and Gynecology, The University of Alabama at Birming­ham School of Medicine, 619 South 20th Street, Birmingham, AL 35233-7333, USA

J. BENJAMIN YOUNGER, M.D. American Society for Reproductive Medicine, 1209 Montgomery Highway, Birm­ingham, AL 35216-2809, USA

HOWARD A. ZACUR, M.D. Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Houck Building, Room 247, Baltimore, MD 21287, USA

Contributors

Introduction

Peritoneoscopy and culdoscopy were first introduced in the second edition of TeLinde's Operative Gynecology in 1953. TeLinde noted, "In many instances we find peritoneoscopy to be a useful procedure. Nevertheless it often left something to be desired." During the subsequent four decades, enormous progress has allowed the expansion of the application of laparoscopy and hysteroscopy throughout gynecol­ogy. Thus, it is appropriate and quite useful to have a text devoted solely to this rapidly advancing specialty.

In its second edition, the text Practical Manual of Operative Laparoscopy and Hys­teroscopy is a complete and honest overview of the field providing the reader with a critical appraisal of the current literature on technique, development, and long­term follow-up. Refreshingly, the authors include not only the American experi­ence but also advances from Europe and Asia.

Ricardo Azziz and Ana Alvarez Murphy have carefully organized the text into general concepts and laparoscopic and hysteroscopic operative techniques. The editors have selected authors of national and international stature to prepare chap­ters in their areas of expertise. The edited text carefully analyzes the advantages and disadvantages of each operative technique so as to allow readers insight as to the proper place for a particular endoscopic technique in their surgical practices.

Finally, I am particularly pleased and proud to have the opportunity to introduce the second edition. Dr. Azziz and Dr. Murphy were both fellows in reproductive en­docrinology and infertility at the Johns Hopkins Hospital and have independently developed an international reputation as authorities in reproductive surgery. I was privileged to have the opportunity to work with both editors and attest to their sur­gical philosophy of careful study of surgical devices and techniques before their ac­ceptance in clinical practice.

John A. Rock, M.D. James Rnbert McCord Professor and Chairman Department of Gynecology and Obstetrics Emory University School of Medicine Atlanta, Georgia

xix