Single-Port Laparoscopic Adnexal Surgery

Abstract

Laparoscopic management of the adnexa in gynecology dates back to the initial descriptions of diagnostic laparoscopy and laparoscopic tubal surgery in the early 1900s. In 1910, a Swedish physician named Jacobeaus was credited with coining the term laparoscopy when he performed the first intraperitoneal “scope” using a cystoscope. Despite the discovery of this novel technique to see inside the abdomen with only a small incision, laparoscopy got off to a slow start in the United States. In the late 1940s, TeLinde and colleagues described the use of a rigid scope placed though the vagina for evaluation of the adnexa. TeLinde termed this culdoscopy and used it in the work-up of fertility patients, as well as to assess for ectopic pregnancy before laparotomy. The visualization of the pelvic abdominal cavities via a transvaginal approach was one of the foundations for natural orifice surgery. Transabdominal laparoscopic visualization of the peritoneal cavity took a little longer to catch on in the United States. It was not until the late 1960s, when descriptions of laparoscopic tubal cauterization using a single-channel operative laparoscope with a mirrored lens began to surface, that operative laparoscopy gained more interest. Since that time, innovations in technology have greatly improved the optics and the safety of laparoscopic equipment, while technical innovations and forward-thinking surgeons have identified new potential applications for operative laparoscopy. The result has been a recent surge in publications on standard laparoscopic, robotic-assisted laparoscopic, and, more recently, single-port laparoscopic management of benign and malignant adnexal conditions. This chapter focuses on single-port laparoscopic management of the adnexa in gynecologic surgery.