Pr. Koninckx et al., CARBON-DIOXIDE LASER FOR LAPAROSCOPIC ENTEROCELE REPAIR, The Journal of the American Association of Gynecologic Laparoscopists, 2(2), 1995, pp. 181-185
The use of the carbon dioxide (CO2) laser for laparoscopic enterocele
repair was evaluated in four women with an enterocele as the only path
ology. Three women had a large enterocele after earlier hysterectomy a
nd one young woman had a congenital enterocele. The technique consists
of vaporizing the peritoneum of the enterocele; however, it is import
ant first to delineate carefully the lesion's circumference because of
the strong retraction during vaporization. Subsequently, a posterior
culdotomy is performed taking care to restore the horizontal position
of the upper vaginal axis by shortening the uterosacral ligaments, whi
ch are sutured together on the midline and the posterior vaginal wall.
The CO2 laser has the advantage that the superficial vaporization it
produces is rapid (<5 min), safe, and completely bloodless. The shrink
ing during vaporization facilitates subsequent repair. Postoperative m
orbidity and recovery were uneventful for all patients. The CO2 laser
seems to have some advantages over sharp endoscopic resection of enter
oceles. The relative simplicity of technique and the low postoperative
morbidity suggest that endoscopy could become routine in pelvic floor
surgery, improving diagnosis and complementing vaginal surgery while
avoiding laparotomy.