Chapter 65: Atlas of Findings in Diagnostic Laparoscopy

Hilgers TW

Infertility Evaluation

Chapter 65: Atlas of Findings in Diagnostic Laparoscopy

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 863-898, 2004

RRM Academy Synopsis

Some endometriosis lesions show only under near-contact laparoscopy

Some endometriosis lesions show up only under near-contact laparoscopy or when tissue is moved aside. This photo atlas draws on one surgeon's over 2,500 diagnostic laparoscopies. Captions also cover scar tissue and fibroids.

Key Findings

The author states that some findings are obvious at first look, while others appear only with near-contact laparoscopy (NCL).
In one image series, dark powder burn lesions in the right posterior cul-de-sac showed up only after the fluid was suctioned off and the uterosacral ligament was pulled aside.
The author states that salpingitis isthmica nodosa may sit in tubes that look perfectly normal at laparoscopy.
With the fimbria under Ringer's lactate, some women with endometriosis had blunted ends. The author says the technique needs further study for diagnosis and prognosis.
The author calls endometriosis inside peritoneal pockets so common that it is to be expected.

RRM Context

Restorative reproductive medicine starts with finding the cause. Surgical NaProTECHNOLOGY, the source of this atlas, puts correct diagnosis at the heart of its surgery. A direct look at the pelvis can find disease that symptoms and a quick view leave hidden. Unexplained infertility means undiagnosed. Endometriosis, adhesions and tubal disease are causes a search can uncover.

Our editorial summary of this paper, not the article's abstract.

Abstract

This chapter is a photographic atlas of findings at diagnostic laparoscopy, intended to build diagnostic skill through repetition and drawn from the author's experience in over 2,500 diagnostic laparoscopies. The atlas covers peritoneal endometriosis, peritoneal pockets, ovarian and tubal endometriosis, salpingitis isthmica nodosa, endometriosis of the bowel, pelvic adhesions, tubal obstruction, polycystic ovaries, uterine leiomyomata, tubal anomalies, peritubal cysts, congenital anomalies and miscellaneous findings. Several findings are observed only with the "near contact" approach or after tissue is retracted, and the chapter states that endometriosis in peritoneal pockets is so common that it is to be expected.

Read the guide

Fertility-Preserving Surgery: Restorative, Specialist, and Conventional Approaches Compared

How fertility-preserving surgery differs by approach: restorative (RRM), specialist, and conventional, across endometriosis, ovarian cysts, PMOS / PCOS, fibroids, tubal disease, Asherman's syndrome, adenomyosis, cesarean scar, pelvic adhesions, and male-factor causes including varicocele and obstruction.

12 min read

Topics

Infertility › Evaluation › Diagnostic Workup · Reproductive Surgery › Laparoscopy › Diagnostic Laparoscopy

Thomas W Hilgers

Tom Hilgers, T Hilgers

Hilgers et al. 2004, Hilgers 2004

Chapter 65: Atlas of Findings in Diagnostic Laparoscopy

Some endometriosis lesions show only under near-contact laparoscopy

Key Findings

RRM Context

Abstract

Read the guide

Topics

By this author

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