Enhancing advanced surgical laparoscopy - Combined, routine use of microlaparoscopes and macrolaparoscopes

OBJECTIVE: To describe a variety of techniques for using the microlaparosco pe in conjunction with a standard-sized laparoscope for simplifying and enh ancing advanced laparoscopic surgery. STUDY DESIGN: Descriptive study of microlaparoscopic techniques for enhanci ng macrolaparoscopic procedures. RESULTS: The microlaparoscope facilitates macrolaparoscopy by permitting: ( 1) specimen removal and use of 10-mm instruments without secondary, large p orts; (2) performance of laparoscopic vaginal hysterectomy with the endosco pic stapler using only one 12-mm port; (3) lysis of difficult pelvic and pe riumbilical adhesions; (4) enhancement of visual access to difficult operat ive sites; (5) closure of large umbilical ann secondary pout sites under di rect monitoring; (6) visualization from the left upper quadrant when umbili cal adhesions are suspected; and (7) use as the initial entry laparoscope w hen extensive surgery is not anticipated. CONCLUSION: The routine, combined use of the microlaparoscope and 10-mm lap aroscope significantly expands the capabilities of the advanced laparoscopi c surgeon. Procedures are simplified, facilitated and made less invasive.