Laparoscopy in gynecologic practice.

A history of the development of laparoscopy and culdoscopy is given along with the current applications of laparoscopy in gynecologic practice. In the authors experience the indications for laparoscopy vary in frequency with the patient population served. At Cook County Hospital Chicago which serves a large medically indigent population demand for sterilization is high. Residual pelvic inflammatory disease and the need to ascertain the character of a pelvic mass are other frequent indications. In private practice laparoscopy is indicated following diagnosis of pelvic pain of unknown origin particularly when endometriosis is suspected and for fertility evaluation. Contraindications are subacute and acute peritonitis some cases of previous laparotomy circulatory decompensation adhesions serious heart or lung disease and diaphragmatic hernia. In the authors experience the most importnat contraindications have been adhesions preventin pneumoperitoneum ileus or intestinal obstruction repaired hernia an infectious process and any condition making the Trendelenburg posture or pneumoperitoneum dangerous. The mortality rate has been reported as less than .1%. Complications have been pain puncture of abdominal blood vessels puncture of other abdominal viscera peritonitis and hepatic coma. After biopsy hemorrhage puncture of a hydatid cyst and bile peritonitis have occurred. If the trocar perforates an intestinal loop immediate surgical intervention is necessary. When the operation is performed with care and correct technique its dangers are minimal and its value warrants its use when indicated. Of the first 61 cases in the authors series 49 were done in the puerperium 12 were not associated with pregnancy. There were no serious complications. Altogether 364 sterilizations were done by the author and his associates. 1 confirmed pregnancy has followed. The need to continue other methods of examination as well as laparoscopy is emphasized.