Laparoscopic Gynecological Surgery

When there is serious adhesion between the ovarian fallopian tube and the peritoneum near the lateral pelvic wall or uterosacral ligament, if the operation is improper, it will cause ureteral injury. It can be caused by instruments or electrical damage. It can be complete transection or partial injury. The consequences are related to the degree of damage, the time of discovery and whether the treatment is timely and appropriate. Once any injury or suspicious injury is found, please consult the urology department for timely and correct treatment, otherwise it will cause serious consequences. The key to prevention is whether doctors have a full grasp of the anatomical position of the ureter in the pelvic cavity and the parts prone to injury. Severe pelvic adhesion often leads to the thickening of the pelvic peritoneum, it is difficult to distinguish the course of the ureter below it, and it is easy to cut off the urinary catheter or cause electrical injury by rash separation, ligation and hemostasis. At this time, the retroperitoneum should be opened first to find the ureter, and then the lysis should be performed after seeing its running direction and the relationship with the adhesion site. Another method is to insert ureteral catheter before operation, which is helpful to identify the position of ureter. Surgical evaluation: simple ovarian and fallopian tube adhesion seems to be rare, and there are often adhesion of other pelvic organs. Or conversely, ovarian tubal adhesion is often part of pelvic adhesion. Therefore, it is more appropriate to call it pelvic adhesion lysis. The operation principles, operation essentials and skills followed by the two are the same, but the latter involves a wider range. Although this operation only involves the release of adhesion, it is actually the basis of other laparoscopic surgery and one of the difficulties of laparoscopic surgery. First of all, all the techniques used in adhesion release, such as clamp, traction, exposure, separation, cutting, electrocautery, electrocoagulation and suture, are the basis of laparoscopic surgery. If you don't master them well, you can't talk about other operations. Secondly, if the pelvic adhesion is not solved and the anatomical position of various tissues and organs is unclear, forcing other operations may cause more serious damage, which is actually a big taboo of surgery. Moreover, pelvic adhesions are often patients with infertility and chronic pelvic pain. If the adhesions are not solved well or more serious adhesions are caused after operation, it is really against the original intention of this operation. Therefore, operators are required to master various skills of laparoscopic surgery, be familiar with the anatomical relationship of important pelvic and abdominal organs, and be able to find abnormalities in time and deal with them effectively. Therefore, this operation is not suitable for beginners.