Laparoscopic and robotic procedures

Introduction Gynecological applications of laparoscopy have contributed greatly to the popularization of laparoscopic surgery. Laparoscopic gynecological surgery has many accepted applications, from diagnostic use to facilitation of hysteroscopy and reconstructive pelvic surgery. According to the American Association of Gynecological Laparoscopists survey of members regarding patterns in the use of laparoscopic procedures, diagnostic laparoscopy was the most commonly performed laparoscopic procedure. Indications for laparoscopy The main indications for diagnostic gynecological laparoscopy include infertility, pelvic pain, pelvic inflammatory disease, suspected pelvic masses, and ectopic pregnancy. The evaluation of pelvic pain and infertility focuses on identification of endometriosis, adhesions, or tubal blockage. Less common indications for minimally invasive procedures (laparoscopy) include evaluation of possible uterine perforation during dilatation and curettage, evaluation of early postoperative complications, removal of foreign bodies, and evaluation of pelvic tumors before laparotomy. The workup prior to performing diagnostic laparoscopy for acute pelvic pain should include documentation of the location, severity and duration of symptoms, last menstrual period, pregnancy test, urinanalysis, and complete blood count. Adhesiolysis Peritoneal adhesions may cause pelvic pain, infertility, and bowel obstruction. Formation of intra-abdominal adhesions between the operative scar and the underlying viscera is a common consequence of laparotomy. Patients with midline incisions have more adhesions than those with Pfannenstiel incisions.