title: Enhancing advanced surgical laparoscopy. Combined, routine use of microlaparoscopes and macrolaparoscopes.
abstract: OBJECTIVE
  To describe a variety of techniques for using the microlaparoscope in conjunction with a standard-sized laparoscope for simplifying and enhancing advanced laparoscopic surgery.
  
  
  METHODS
  Descriptive study of microlaparoscopic techniques for enhancing macrolaparoscopic procedures.
  
  
  RESULTS
  The microlaparoscope facilitates macrolaparoscopy by permitting: (1) specimen removal and use of 10-mm instruments without secondary, large ports; (2) performance of laparoscopic vaginal hysterectomy with the endoscopic stapler using only one 12-mm port; (3) lysis of difficult pelvic and periumbilical adhesions; (4) enhancement of visual access to difficult operative sites; (5) closure of large umbilical and secondary port sites under direct monitoring; (6) visualization from the left upper quadrant when umbilical adhesions are suspected; and (7) use as the initial entry laparoscope when extensive surgery is not anticipated.
  
  
  CONCLUSIONS
  The routine, combined use of the microlaparoscope and 10-mm laparoscope significantly expands the capabilities of the advanced laparoscopic surgeon. Procedures are simplified, facilitated and made less invasive.
authors.affiliation: Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA 98431, USA. col_milo_hibbert@smtplink.mamc.amedd.army.mil
authors.forename: M L
authors.initials: ML
authors.lastname: Hibbert
authors.forename: P E
authors.initials: PE
authors.lastname: Palacio
authors.forename: F W
authors.initials: FW
authors.lastname: Larsen
authors.forename: G D
authors.initials: GD
authors.lastname: Davis
authors.forename: R P
authors.initials: RP
authors.lastname: Perez
mesh_terms: D019723:Endoscopes; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation*; D006801:Humans; D020706:Laparoscopes; D013048:Specimen Handling