Hilgers, T. W. (2004). Chapter 69: Laparoscopic Laser Lysis of Adhesions. In The Medical and Surgical Practice of NaProTECHNOLOGY (pp. 945-950).
Hilgers TW. Chapter 69: Laparoscopic Laser Lysis of Adhesions. In: The Medical and Surgical Practice of NaProTECHNOLOGY. 2004. p. 945-950.
Hilgers, T. W. "Chapter 69: Laparoscopic Laser Lysis of Adhesions." The Medical and Surgical Practice of NaProTECHNOLOGY, 2004, pp. 945-950.
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Pope Paul VI Institute for the Study of Human Reproduction, Omaha, Nebraska.027jqx654
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RRM Academy Synopsis
Laparoscopic laser can lyse mild pelvic adhesions and relieve symptoms
A surgeon's textbook chapter says laser can free mild pelvic adhesions and relieve symptoms. The chapter calls adhesions to the uterus and abdominal wall suited to laser if mild. Extensive adhesions near the bowel call for slow, exact work.
Key Findings
The chapter calls adhesions to the uterus from earlier surgery (not very severe) and to the abdominal wall underside after cesarean section or hysterectomy particularly suited to laser.
The chapter uses a suction irrigator for counter traction, so the laser sits close to where the adhesion meets the tissue, purposely away from bowel.
The KTP laser appears superior in many pelvic adhesions. The Nd:YAG laser is clearly superior for abdominal wall adhesions because it coagulates blood vessels better.
After an extensive dissection, some adhesions will almost certainly form again, so the chapter would not recommend that procedure for people wishing to preserve fertility.
Interpretation
The chapter teaches surgical technique. A surgeon aims the laser along the adhesion's own plane, staying clear of the bowel and other nearby organs. Laser type is matched to location. KTP works well on many pelvic adhesions. Nd:YAG works well on abdominal wall adhesions because it seals blood vessels better. The surgeon frees organs bound by scar tissue with less harm to nearby tissue. The authors note that adhesions often form again after an extensive dissection. For that reason, they reserve this approach for patients who are not trying to preserve fertility.
RRM Context
The chapter comes from a surgical NaProTECHNOLOGY textbook by Dr. Thomas W. Hilgers, who developed the method. The technique pairs adhesion removal with an adhesion barrier placed afterward. Removing adhesions to restore pelvic anatomy follows the restorative principle of treating a cause of pain and infertility.
Our editorial summary of this paper, not the article's abstract.
Abstract
This chapter describes laparoscopic laser lysis of pelvic adhesions, which Hilgers considers almost an ideal use of the laser when the adhesions are not too severe. The chapter reports that the KTP laser appears superior for many adhesions around the pelvic tissues, and the Nd:YAG laser for adhesions to the undersurface of the anterior abdominal wall, because it coagulates blood vessels better. Illustrated cases include a sigmoid fat tag adhered to the uterus, a peritubal adhesion to the ovary and an omental adhesion to the abdominal wall, and the chapter stresses leaving intact any attachment that appears connected directly to bowel. For an extensive adhesiolysis performed for chronic pelvic pain in a woman whose family was complete, the chapter states that adhesions are likely to re-form and that this type of adhesiolysis would not be recommended for women wishing to preserve fertility.
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.
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