Monday, October 26, 2009

Laparoscopy for Pelvic Adhesions

Laparoscopy for Pelvic Adhesions

Pelvic adhesions (scars) develop as a normal tissue response to inflammation, which occurs whenever the tissue is damaged. Infertility surgeons make every attempt to limit or prevent pelvic adhesion formation following laparoscopy or laparotomy, and an experienced fertility surgeon may be able to significantly reduce the bulk of previously formed pelvic adhesions through meticulous care at laparoscopy.

Ideally, infertility surgery adheres to the principles of “microsurgical technique,” a set of surgical methods designed to reduce adhesion formation. Crush injuries to tissue can result in scar formation, so very gentle tissue handling is encouraged. Blood is very irritating to the lining cells overlying the pelvis, called peritoneum, so thorough control of even small amounts of bleeding and removal of any blood collected in the pelvis and abdomen is important. Identification of the proper tissue planes is important in order to avoid surgical damage to the tissues that are being separated so magnification should be available when needed. Tissues that dry out become damaged much more easily than tissues that are kept moist, and it is much easier to maintain adequate tissue moisture during laparoscopy as compared to laparotomy since the abdomen is essentially closed during the laparoscopy procedure. Infection should be avoided (and if inevitable then infection should be treated as early as possible) since a pelvic infection can rapidly destroy the very delicate reproductive tissues. Carbon deposits or char caused by the use (or overuse) of cautery to burn or sear abnormal tissues or control bleeding can result in adhesion formation and should be minimized whenever appropriate. Devascularization of tissue or ischemia can result from burn injuries that damage the blood vessels feeding tissues, so use of the ultrapulse CO2 laser is ideal for many infertility laparoscopy procedures since this tool allows vaporization of unwanted tissue with minimal lateral thermal damage to surrounding tissues.

Dr Eric Daiter at The NJ Center for Fertility and Reproductive Medicine, LLC has personally performed over a thousand laparoscopy surgeries using the ultrapulse CO2 laser for the treatment of pelvic adhesions during the past 20 years. He would be happy to help you. Contact the office at 908 226 0250 for an appointment. Also, visit us on the web at or

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