Microsurgical principles and postoperative adhesions: lessons from the past.
Identifieur interne : 000007 ( OpenAccess/Analysis ); précédent : 000006; suivant : 000008Microsurgical principles and postoperative adhesions: lessons from the past.
Auteurs : Victor Gomel [Canada] ; Philippe R. Koninckx [Belgique]Source :
- Fertility and sterility [ 1556-5653 ] ; 2016.
Abstract
"Microsurgery" is a set of principles developed to improve fertility surgery outcomes. These principles were developed progressively based on common sense and available evidence, under control of clinical feedback obtained with the use of second-look laparoscopy. Fertility outcome was the end point; significant improvement in fertility rates validated the concept clinically. Postoperative adhesion formation being a major cause of failure in fertility surgery, the concept of microsurgery predominantly addresses prevention of postoperative adhesions. In this concept, magnification with a microscope or laparoscope plays a minor role as technical facilitator. Not surprisingly, the principles to prevent adhesion formation are strikingly similar to our actual understanding: gentle tissue handling, avoiding desiccation, irrigation at room temperature, shielding abdominal contents from ambient air, meticulous hemostasis and lavage, avoiding foreign body contamination and infection, administration of dexamethasone postoperatively, and even the concept of keeping denuded areas separated by temporary adnexal or ovarian suspension. The actual concepts of peritoneal conditioning during surgery and use of dexamethasone and a barrier at the end of surgery thus confirm without exception the tenets of microsurgery. Although recent research helped to clarify the pathophysiology of adhesion formation, refined its prevention and the relative importance of each factor, the clinical end point of improvement of fertility rates remains demonstrated for only the microsurgical tenets as a whole. In conclusion, the principles of microsurgery remain fully valid as the cornerstones of reproductive microsurgery, whether performed by means of open access or laparoscopy.
DOI: 10.1016/j.fertnstert.2016.08.040
PubMed: 27692286
Affiliations:
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Electronic address: victorgomel1@gmail.com.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Obstetrics and Gynecology, University of British Columbia, Women's Hospital, Vancouver, British Columbia</wicri:regionArea><wicri:noRegion>British Columbia</wicri:noRegion></affiliation></author><author><name sortKey="Koninckx, Philippe R" sort="Koninckx, Philippe R" uniqKey="Koninckx P" first="Philippe R" last="Koninckx">Philippe R. Koninckx</name><affiliation wicri:level="1"><nlm:affiliation>Department of Obstetrics and Gynecology, Catholic University Leuven, University Hospital, Gasthuisberg, Leuven, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Obstetrics and Gynecology, Catholic University Leuven, University Hospital, Gasthuisberg, Leuven</wicri:regionArea><wicri:noRegion>Leuven</wicri:noRegion></affiliation></author></analytic><series><title level="j">Fertility and sterility</title><idno type="eISSN">1556-5653</idno><imprint><date when="2016" type="published">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">"Microsurgery" is a set of principles developed to improve fertility surgery outcomes. These principles were developed progressively based on common sense and available evidence, under control of clinical feedback obtained with the use of second-look laparoscopy. Fertility outcome was the end point; significant improvement in fertility rates validated the concept clinically. Postoperative adhesion formation being a major cause of failure in fertility surgery, the concept of microsurgery predominantly addresses prevention of postoperative adhesions. In this concept, magnification with a microscope or laparoscope plays a minor role as technical facilitator. Not surprisingly, the principles to prevent adhesion formation are strikingly similar to our actual understanding: gentle tissue handling, avoiding desiccation, irrigation at room temperature, shielding abdominal contents from ambient air, meticulous hemostasis and lavage, avoiding foreign body contamination and infection, administration of dexamethasone postoperatively, and even the concept of keeping denuded areas separated by temporary adnexal or ovarian suspension. The actual concepts of peritoneal conditioning during surgery and use of dexamethasone and a barrier at the end of surgery thus confirm without exception the tenets of microsurgery. Although recent research helped to clarify the pathophysiology of adhesion formation, refined its prevention and the relative importance of each factor, the clinical end point of improvement of fertility rates remains demonstrated for only the microsurgical tenets as a whole. In conclusion, the principles of microsurgery remain fully valid as the cornerstones of reproductive microsurgery, whether performed by means of open access or laparoscopy.</div></front></TEI><affiliations><list><country><li>Belgique</li><li>Canada</li></country></list><tree><country name="Canada"><noRegion><name sortKey="Gomel, Victor" sort="Gomel, Victor" uniqKey="Gomel V" first="Victor" last="Gomel">Victor Gomel</name></noRegion></country><country name="Belgique"><noRegion><name sortKey="Koninckx, Philippe R" sort="Koninckx, Philippe R" uniqKey="Koninckx P" first="Philippe R" last="Koninckx">Philippe R. Koninckx</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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