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ROLE OF MICROLAPAROSCOPY IN CONSCIOUS PAIN MAPPING

ROLE OF MICROLAPAROSCOPY. IN CONSCIOUS PAIN MAPPING. INTRODUCTION. Chronic pelvic pain is defined as pain that has . lasted 6 months or longer and is severe enough to . affect a woman's daily functioning and personal . relationships. These symptoms are usually unresolved . with conservative me

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ROLE OF MICROLAPAROSCOPY IN CONSCIOUS PAIN MAPPING

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    1. ROLE OF MICROLAPAROSCOPY IN CONSCIOUS PAIN MAPPING DR ASHRAF ATIA DEWIDAR MD MRCOG EGYPT & K.S.A

    5. Chronic Pelvic Pain Chronic pelvic pain is defined as the intermittent or constant pain in the lower abdomen or pelvis of at least 6 months’ duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy. Living with any chronic pain carries a heavy economic and social price. DR ASHRAF ATIA DEWIDAR MD MRCOG EGYPT KSA

    6. Microlaparoscopy is a laparoscopy using instruments less than 5 mm in diameter. Major benefits associated with the use of microlaparoscopy: plays a valuable role in pelvic pain mapping safer than the traditional laparoscopy in patients with multiple abdominal scars scars are more cosmetic can be done under local anesthesia

    7. MICROLAPAROSCOPE INSTRUMENTS Laparoscope less than 5 mm in diameter Less than 1 mm semi rigid fiber optic scope Less than 2 mm scope in diameter 2 and 3 mm rigid fiber optic or glass lens scopes DR ASHRAF ATIA DEWIDAR MD MRCOG EGYPT KSA

    8. Microlaparoscopy Instruments DR ASHRAF ATIA DEWIDAR MD MRCOG EGYPT KSA

    9. Conscious Pain Mapping Conscious pelvic pain mapping has added an innovative diagnostic dimension previously absent in gynecology. Because the patient is awake for the entire microlaparoscopic procedure, she can provide crucial information as an active member of the surgical team. The patient is able to help the surgeon locate the source of pain. DR ASHRAF ATIA DEWIDAR MD MRCOG EGYPT KSA

    10. The areas of concern are examined laparoscopically in a lightly sedated patient. The patient then directs the physician to the area of concern. Careful in vivo examination often reveals pathologic conditions that are not recognized by other means. When the source of pain has been identified, subsequent treatment steps are often clear. Conscious Pain Mapping DR ASHRAF ATIA DEWIDAR MD MRCOG EGYPT KSA

    12. To evaluate the use of microlaparoscopy in conscious pain mapping in cases with pelvic pain. This is a new modality in Tanta University Hospital. DR ASHRAF ATIA DEWIDAR MD MRCOG EGYPT KSA

    14. This study was conducted over a period of 2 years involving one hundred patients who were admitted in the gynaecology department at Tanta University Hospital, Egypt. Patients were divided into 3 groups according to their complaints: First group: patients with dysmenorrhea (n. =16) Second group: patients with dyspareunia (n. =23) Third group: patients with chronic pelvic pain (n. =61) DR ASHRAF ATIA DEWIDAR MD MRCOG EGYPT KSA

    15. Selection Criteria Age: 19 – 40 years old Average body weight Exclusion Criteria Contraindication to conscious sedation techniques Very obese patients Virginity DR ASHRAF ATIA DEWIDAR MD MRCOG EGYPT KSA

    16. Methods DR ASHRAF ATIA DEWIDAR MD MRCOG EGYPT KSA

    17. Timing DR ASHRAF ATIA DEWIDAR MD MRCOG EGYPT KSA

    19. The nerves conducting the pain pass next to the cervix. Blocking nerve conduction at this point blocks pain. DR ASHRAF ATIA DEWIDAR MD MRCOG EGYPT KSA Paracervical block

    20. Injected a total of 20 cc of 1% Lidocaine into the lateral vaginal fornices, with injection sites of 10, 8, 2, and 4 o'clock. (5 cc in each site) DR ASHRAF ATIA DEWIDAR MD MRCOG EGYPT KSA

    21. Iowa Trumpet (top), Needle (middle), and plastic needle spacer to limit depth of penetration of the needle to 5 mm. DR ASHRAF ATIA DEWIDAR MD MRCOG EGYPT KSA

    22. Pain Mapping Procedure DR ASHRAF ATIA DEWIDAR MD MRCOG EGYPT KSA

    23. DR ASHRAF ATIA DEWIDAR MD MRCOG EGYPT KSA

    24. DR ASHRAF ATIA DEWIDAR MD MRCOG EGYPT KSA

    25. Pain Mapping Procedure DR ASHRAF ATIA DEWIDAR MD MRCOG EGYPT KSA

    26. DR ASHRAF ATIA DEWIDAR MD MRCOG EGYPT KSA

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    33. Endometriosis DR ASHRAF ATIA DEWIDAR MD MRCOG EGYPT KSA

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    36. Dose of diazepam and fentanyl used in conscious pain mapping. DR ASHRAF ATIA DEWIDAR MD MRCOG EGYPT KSA

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