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KMID : 0358419750180120985
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Korean Journal of Obstetrics and Gynecology
1975 Volume.18 No. 12 p.985 ~ p.994
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Laparoscopy in Gynecology
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姜信明/Kang, Shin Myung
禹敬淑/洪性善/劉漢基/金明淑/Woo, Kyung Sook/Hong, Sung Sun/Yu, han Ki/Kim, Myung Sook
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Abstract
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Laparoscopic application in Gynecology is now getting more and more important and practical. 816 cases of laparoscopy has been experienced at Ewha Womans University Hospital during past 2 years and 3 months period from May 1, 1973 to, July 30, 1975. The data to be presented are 800 cases of Tubal- sterilization (469 of interval sterilization and 331 of sterilization plus suction" curettage of the uterus for termination of pregnancy) and 16 cases of diagnostic laparoscopies (3 suspected of having ectopic pregnancy, 4 acute pelvic pain, 5 possible . migrated intrauterine
devices and 4 patients of having infertility).
In most cases the laparoscopies were satisfactorily performed under the local ´ anesthesia using 10mg valium and followed by 50mg of Demerol intravavenously except additional surgery or perineorraphy required at a time.
In the laparoscopic sterilization one incision, electrocoagulation and dividing technique were used.
In view of the sterilization acceptor´s motivation it interestingly encugh noticed that majority of Korean mothers (48%) perfer to have 2 living boys with or without girls and one quarter of the mothers or most ideal family size was considered to have 3 living children, preparably 2 boys and one girl instead of another family size with one boy and one girl which accounting for only 12% Thus a major factor of the acceptability for sterilization lie in the, number of living male boy.331 cases (42%) of laparoscopic sterilization combined with suction curettage for termination of early pregnancy was carried out without any increased morbidity or further additional anesthetic medications.
In 16 cases of diagnostic laparoscopy, we found significant values in variety of the clinical fields. Of 3 suspected ectopic pregnancy, all was confirmed and was operated on before the rupture. In 4 cases of acute pelvic pain, 2 cases were able to avoid unnecessary laparotomy by direct laparoscopic visualization because of one was a nega
tive finding and the other was acute salpingitis. 5 cases of possible intramural or intrapelvic migration of intrauterine devicies were all comffiuied and it was removed by laparotomy. Of 4 cases ofl´infertility, 3 found to be tubal occlusion and one non polycystic ovaries-anoulatory by transuterine and tubal instilation of Indigocarmine solution as well as direct visualization.
There were 3 cases (0.37 %) of major complications requiring laparotomy in 816 cases of laparoscopic procedures. One bleeding case from proximale tubal mesosalpinx resulted from coexisting hypertension following. tubas coagulation or sterilization, and the immediate unilateral salpingectomy and oophorectomy (left) were required. Another case of bleeding from ovarian cyst due to instrumental scratching was cont roled by simple sutures. 1 case of ileum burn were required the simple closure in 26 hours and discharged well without long hours stay in hospital. There was no mortality in this series.
There were no procedural failures encountered in 28 cases of the patients with past history of abdominal surgery. Thus previous srugery is considered as less contraindication for the laparoscopy but through history taking is required for any previous pelvic imflammatory disease or especially peritonitis even though without previous surgery.
We have found only 4 cases- or 0.5% of low failure rate or pregnancy rate in 800 cases of laparoscopic sterilization. 3 cases were considered due to the incomplete coagulation or technical failure of dividing tube. Another case was already: pregnant or in luteal phase of pregnancy at the time of operation.
Laparoscopic procedure is not only valuable in tubal sterilization but also in confirming pelvic pathology and female infertility. Major complication easily be avoided as long as it is done by one adequately trained gynecologist or surgeon.
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