Laparoscopy in gynecology.

Laparoscopy is an operation in which a fiberoptic telescope and accessory instruments are inserted through the anterior abdominal wall into the peritoneal cavity. It is valuable in the search for causes of female infertility menstrual disorders such as oligomenorrhea and amenorrhea unexplained pelvic pain and adnexal masses. The technique permits a prompt and accurate diagnosis of endometriosis and acute salpingitis. First a pneumoperitoneum is formed through a Verres needle by instilling CO2 gas. Then through a skin incision below the umbilicus a trocar and sleeve are inserted. The fiberoptic telescope is then exchanged for the trocar. Accessory insulated forceps probes and an aspirator are inserted through a separate suprapubic midline puncture. The patient is in a modified Trenedeluberg position. The pelvic organs can then be identified manipulated and examined. In over 2000 examinations complications have been few and never serious. There have been no deaths. Contraindications are cancer involving the anterior abdominal wall severe pulmonary disease advanced cardiac disease intestinal obstruction and large pelvic masses. Shock from hemorrhage calls for laparotomy. Extensive peritoneal adhesions and a large diaphragmatic hernia are also contraindications. Obesity is not a contraindication. Biopsy material from the ovary can be obtained. Origins of adnexal masses can be identified. Cysts may be aspirated. A rapid safe and permanent tubal sterilization may be done.