Contribution to minimize the aggressiveness of laparoscopic surgery in gynecology

Tese de Doutoramento em Medicina. ; In recent years, many efforts have been made by endoscopic surgeons to further minimize surgical trauma and invasiveness of their procedures. In a surgical approach, three aspects should be taken into account: the surgical access, the extension of surgical dissection and the amount of excised tissue. The surgical access should be the smallest possible to cause the lowest operative damage. The extension of operative dissection should be the minimal required in order to avoid unnecessary trauma or morbidity related to the procedure (e.g. lymphocele after lymphadenectomy or nervous injury during genital prolapse correction). The amount of extirpated or excised tissue should be the strictly necessary. There is no need to remove extra tissue what may cause supplementary damage. Therefore, we should tailor the surgery to reach our three previous objectives for reducing the surgical aggressiveness to the minimum possible. With a current emphasis on diminishing the visibility of scars, on increasing the surgical precision and on decreasing the amount of dissection, minilaparoscopy has reemerged as an appealing option for surgeons. Thus, in our research work we aimed to test the use of minilaparoscopic instruments in some innovative gynecological surgical procedures like the image-guided sentinel lymph node (SLN) approach and the genital prolapse correction. In our experiments, we confirmed the feasibility of the minilaparoscopic surgical approach for identification, and excision of SLN by an intraperitoneal acess. Furthermore, the feasibility and reliability of an extraperitoneal minilaparoscopic approach for SLN excision using a near infrared imaging system and indocyanine green was demonstrated. These procedures might be considered a potentially better alternative to traditional laparoscopy during staging procedures for gynecological malignancies. Concerning the genital prolapse correction, we demonstrated that minilaparoscopy is a reliable and attractive approach for sacrocolpopexy ...