Seven-year experience with office microlaparoscopy and hysteroscopy

Since 1989 more than 1200 office-based endoscopies have been performed at our facility. Visualization was initially achieved with 1.6-mm optical catheters, but recently, we have used larger-diameter fiber and glass rod endoscopes. Ancillary instruments progressed from 5- to 2-mm diameters, although occasionally we used up to 20-mm cannula punctures. Anesthesia remained consistent, with local infiltration followed by conscious sedation given by an on-site anesthesiologist. Lately, alternative methods of anesthesia including hypnosis and acupuncture have had some initial success. To date, we have performed 156 tubal ligations, 293 diagnostic laparoscopies, 151 treatments of endometriosis, 43 ovarian cyst aspirations, 29 adhesiolyses, 263 second-look procedures, 21 ectopic pregnancy removals, 198 diagnostic hysteroscopies, 64 endometrial biopsies, 20 fibroid resections, and 39 endometrial ablations. Patient response has been rewarding, thanks to decreased time off work, decreased cost of procedures to health insurance carriers, and immediate satisfaction from the diagnosis and treatment of their conditions.