Ml. Hibbert et al., Enhancing advanced surgical laparoscopy - Combined, routine use of microlaparoscopes and macrolaparoscopes, J REPRO MED, 44(1), 1999, pp. 1-6
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.