of Tubal Patency
Division via Laparoscopy
Modified Irving Technique
Sterilization - Ucheda Technique
of the Fallopian Tube
of the Ovary
of the Ovary
Ovarian Biopsy via Laparoscopy
Biopsy of the ovary is rarely necessary. Modern cytogenetic and endocrine
laboratory techniques can usually ascertain whether the ovary contains
oocytes. There are some cases, however, in which biopsy of the ovary
may be indicated.
The purpose of the operation is to obtain an adequate biopsy of the
ovary through the laparoscope.
Physiologic Changes. Removal of a piece of ovary
can, in some cases, change the physiology of the hypothalamic-pituitary-ovarian
axis in the same manner as wedge resection of the ovary alters the
physiology in polycystic ovary disease.
Points of Caution. The
predominant complication from ovarian biopsy is control of hemorrhage
from the bed of the ovary. Thorough electrocoagulation of the entire
biopsy site should be performed. The site should be observed for
at least 3-4 minutes to ensure that hemostasis is complete.
Ovarian biopsy by laparoscopy requires a
two-incision technique. It is preferable to use an operating
laparoscope with a 3-mm grasping forceps to grasp the suspensory
ligament of the ovary and anchor the ovary in a stable position.
A 6-mm alligator biopsy forceps
is passed through a second-incision trocar, and a large bite
of ovarian capsule and stroma is taken. Bleeding from this site
can be copious and must be coagulated. If bleeding obscures observation
of the biopsy site, a third puncture is made in the abdominal
wall. A 2-mm aspiration needle connected to a 50-mL syringe of
saline solution is introduced through the puncture, and the biopsy
site is irrigated with saline solution rather than suctioned.
A large electrocoagulation biopsy
forceps is inserted through the second-incision trocar into the
biopsy wound, and the jaws of the forceps are opened. The electrical
current is applied, and the ovary is coagulated thoroughly from
the inside. This usually stops most of the bleeding. The site
is irrigated with saline solution. The biopsy forceps can be
applied to small bleeding areas with the jaws in the closed position,
providing point cautery rather than widespread cautery. The ovary
should be observed for at least 3-4 minutes to ensure that all
bleeding is stopped prior to removing the instruments from the