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David ADAMSON

Fertility Physicians of Northern California
Palo Alto, United States
MD
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Principles of laparoscopic reproductive surgery
Professor Adamson exposes the rules for laparoscopic reproductive surgery. Laparoscopy is first part of the diagnosis, such as ultrasonography or hysterosalpingography. Preoperative principles rely on the informed and signed consent of the patient. Professor Adamson then covers intraoperative rules such as the importance of a good vizualisation (i.e., exposure), control of the surgical field, and proper use of energy sources. Prevention of adhesions is essential because the rate of adhesion is lower with laparoscopy than with laparotomy; it is however quite high (65-88%). A microsurgical technique associated with anti-adhesion barriers seems to be effective. At the end of laparoscopic surgery, the surgeon must give the patient a prognosis for fertility: the Endometriosis Fertility Index seems to be a very useful tool.
D Adamson
Lecture
6 years ago
1170 views
4 likes
1 comment
29:56
Principles of laparoscopic reproductive surgery
Professor Adamson exposes the rules for laparoscopic reproductive surgery. Laparoscopy is first part of the diagnosis, such as ultrasonography or hysterosalpingography. Preoperative principles rely on the informed and signed consent of the patient. Professor Adamson then covers intraoperative rules such as the importance of a good vizualisation (i.e., exposure), control of the surgical field, and proper use of energy sources. Prevention of adhesions is essential because the rate of adhesion is lower with laparoscopy than with laparotomy; it is however quite high (65-88%). A microsurgical technique associated with anti-adhesion barriers seems to be effective. At the end of laparoscopic surgery, the surgeon must give the patient a prognosis for fertility: the Endometriosis Fertility Index seems to be a very useful tool.
Fertility enhancing surgery
Professor David Adamson focuses on the role of laparoscopy in subfertile patients. Laparoscopy helps to diagnose and manage many gynecologic conditions that may induce spontaneous pregnancy and enhance Assisted Reproductive Technology (ART) results. In endometriosis, laparoscopy is required to establish the diagnosis and provide a better vision: it is first recommended in stage I-II by the American Society for Reproductive Medicine (ASRM). It should be considered in stage III-IV if the patient is young and after several IVF failures. Laparoscopic cystectomy is suitable if endometrioma is larger than 4cm prior to IVF. Myomas have to be removed when they distort the cavity or when they are intramural and voluminous. Laparoscopic myomectomy must be carried out by skilled surgeons. Adnexal masses should be removed if they exceed 5cm and persist for more than 3 months. Concerning polycystic ovarian syndrome (PCOS), ovarian drilling is indicated in case of failure of controlled ovarian hyperstimulation (COH). Laparoscopy is very useful for distal tubal occlusion to assess the quality of the tube and perform fimbrioplasty. It is also useful for ectopic pregnancy and sterilization reversal. As a conclusion, laparoscopy in subfertile patients must be performed in young women, without other infertility factors. Laparoscopy should also be envisaged when the disease is treatable and when the patients agree to have a 9 to 15 months’ interval prior to IVF.
D Adamson
Lecture
6 years ago
2360 views
16 likes
0 comments
26:49
Fertility enhancing surgery
Professor David Adamson focuses on the role of laparoscopy in subfertile patients. Laparoscopy helps to diagnose and manage many gynecologic conditions that may induce spontaneous pregnancy and enhance Assisted Reproductive Technology (ART) results. In endometriosis, laparoscopy is required to establish the diagnosis and provide a better vision: it is first recommended in stage I-II by the American Society for Reproductive Medicine (ASRM). It should be considered in stage III-IV if the patient is young and after several IVF failures. Laparoscopic cystectomy is suitable if endometrioma is larger than 4cm prior to IVF. Myomas have to be removed when they distort the cavity or when they are intramural and voluminous. Laparoscopic myomectomy must be carried out by skilled surgeons. Adnexal masses should be removed if they exceed 5cm and persist for more than 3 months. Concerning polycystic ovarian syndrome (PCOS), ovarian drilling is indicated in case of failure of controlled ovarian hyperstimulation (COH). Laparoscopy is very useful for distal tubal occlusion to assess the quality of the tube and perform fimbrioplasty. It is also useful for ectopic pregnancy and sterilization reversal. As a conclusion, laparoscopy in subfertile patients must be performed in young women, without other infertility factors. Laparoscopy should also be envisaged when the disease is treatable and when the patients agree to have a 9 to 15 months’ interval prior to IVF.