Principles of Microsurgical Techniques in Infertility

ISBN-13: 9781468440126 / Angielski / Miękka / 2012 / 310 str.

J. Victor Reyniak; Niels H. Lauersen

Opis

While this world eagerly awaits the ideal contraceptive technique that could efficiently, safely, and esthetically save this planet from the starvation and squalor of over- crowding and offer women control over their reproductive capacity, the individual faced with the frustration, even des- peration, induced by infertility begs for help in achieving the desired conception. The discipline of gynecology and obstetrics, recogniz- ing the importance of these problems and the need for spe- cial expertise in reproductive endocrinology and its atten- dant clinical challenges in fertility and infertility, has now formalized the training of specialists in this area of scientific knowledge in a further effort to advance the skills of diag- nosis and treatment attendant on these complex problems. Slowly but steadily, as befits the complexity of the endocrine and metabolic pathways involved, the scientific basis of reproductive physiology has been revealed by the research of physicians, biochemists, and physiologists. It is clear that no significant clinical advance can be made with- out the foundation of such new knowledge. Indeed, the successful treatment of infertility resulting from failure of ovulation was based on just such a scientific advance.

Spis treści

1 Principles of Microsurgery in Infertility.- Microsurgical Training 3 Microsurgical Principles 5 References 9.- 2 Physiology of the Fallopian Tube.- Tubal Anatomy 12 Tubal Physiology 17 References 34.- 3 Pathophysiology of the Fallopian Tube in Infertility.- Inflammatory Diseases 40 Ectopic Pregnancy 55 Endometriosis 60 Pathology of Sterilization and Tubal Reconstructive Surgery 62 Tumors 64 References 66.- 4 Microsurgical Technical Aids and Instrumentation.- Surgeon 70 The Microsurgical Team 71 Positioning the Patient on the Operating Table 72 Type of Incision 73 Aids to Proper Exposure 73 The Chair 76 Selection of Magnification 76 Instruments 82 Suture 91 Holding of Instruments 92 Positioning of Tissue 93 Concluding Thoughts 93.- 5 Patient Selection and Preoperative Counseling.- 95 Candidates for Microsurgery 96 Patient Counseling 98 Chance of Success 101 Preoperative Infertility Investigation 112 Conclusion 116 References 117.- 6 Endoscopy in the Evaluation of Infertile Patients.- Laparoscopy 125 Hysteroscopy 128 Hysterosalpingogram 129 Preoperative Endoscopic Evaluation before Tubal Reanastomosis 131 Preoperative Endoscopic Evaluation in Tubal Occlusive Disease 132 Endoscopic Evaluation in Unexplained Infertility 136 Summary 137 References 137.- 7 Reversal of Female Sterilization.- Macro- and Microsurgical Methods of Sterilization Reversal 141 Problems and Controversies 153 Postoperative Follow-up and Planning of Pregnancy 155 Causes of Failure in Sterilization Reversal 155 Summary 157 References 157.- 8 Microsurgical Management of Distal Tube Disease.- General Principles 161 Instrumentation 162 Suggested Pre- and Postoperative Medication 165 Entrance into the Abdomen 165 Salpingolysis 165 Classification of Tubal Disease 169 Fimbrioplasty 171 Salpingoneostomy 175 Coexistent Proximal and Distal Tubal Occlusion 179 Factors Leading to Conception Failure after Tuboplasty 180 Conclusions 181 References 182.- 9 Uterotubal Implantation.- Uterotubal Junction 186 Diagnostic Techniques 186 Surgical Techniques 187 Postoperative Therapy 196 Complications 196 Failure of Uterotubal Implantation 197 Results and Discussion 199 References 205.- 10 Conservative Techniques for the Management of Tubal Pregnancies.- Techniques 208 General Comments 213 Summary 216 References 217.- 11 Postoperative Adhesions: Etiology and Prevention.- Pathogenesis of Peritoneal Adhesions 220 Prophylaxis of Peritoneal Adhesions 224 Summary 229 References 229.- 12 Hormonal and Surgical Management of Pelvic Endometriosis.- Endometriosis and Infertility 235 Classification of Endometriosis 237 Hormonal Management 239 Pseudomenopause 241 Pseudopregnancy 251 Other Hormonal Methods 255 Surgical Management 257 Combined Hormonal and Surgical Management 261 Individualized Approach to Treatment 262 References 269.- 13 Magnified Surgery of the Vas Deferens.- Vasovasostomy 274 Anatomic and Physiological Considerations 274 Results 276 Surgical Technique of Vasovasostomy 278 Epididymovasostomy 282 References 288.