|May 2002 · Vol. 14, No. 5
Adhesions affect the quality of life of more than half of all women who undergo pelvic surgery and are common sequelae of endometriosis and infectious processes. Laparoscopic resection—done with the proper technique—offers a safe, efficacious treatment option.
Dr. Cohen is associate clinical professor of obstetrics and gynecology and director of the Center for Women’s Minimal Access Surgery at Columbia University in New York City.
Inspect the pelvic cavity prior to beginning adhesiolysis because the peritoneum becomes more opaque as the surgery progresses, obscuring anatomical definition.
Grasp adhesions from the side contralateral to where you plan to make the first cut.
Divide superficial adhesions first to ensure unimpeded access to deeper ones in case bleeding occurs.
Coagulate thick or vascular adhesions with bipolar coagulation prior to division.
Cut adhesions at both ends and remove the tissue rather than just dividing it.
Although more than 50% of all women who undergo pelvic or abdominal surgery will develop adhesions, the condition garners limited attention in the literature and from physicians. And, yet, the problems—infertility, chronic pelvic pain, and bowel obstruction, to name a few—with which patients present to Ob/Gyns every day often can be attributed to pelvic adhesions. In short, the quality of life of a significant number of women is affected by this condition, warranting a detailed look at the laparoscopic technique of adhesiolysis.