Gynecology

Operative laparoscopy is a well-know modality in the efficacious treatment of gynecological lesions. Gynecologists were among the first surgical specialists to embrace laparoscopy in the United States in the early 1980s. Initial uses were primarily diagnostic, but as skills and equipment improved, operative techniques became widely employed. Hysterectomy, performed either abdominally or vaginally, is one of the most common gynecological operations performed in the United States. Reich et al. reported the first laparoscopic hysterectomy in the United States in 1989. Since that time, the laparoscopic approach to hysterectomy and oophorectomy has gained increasing popularity in some centers in the United States and Europe and has been used for a wide range of conditions. Although multiple variations have been described, including total laparoscopic supracervical hysterectomy with morcellation and laparoscopic removal of the uterus, the more common procedure involves combining laparoscopically directed dissection of the adnexa and upper uterine attachments with vaginal hysterectomy-a laparoscopic assisted vaginal hysterectomy (LAVH). Considerable controversy exists concerning appropriate indications for traditional vaginal hysterectomy. Traditionally laparotomy, a major surgical procedure, has been advocated as the technique of choice for treatment of adnexal masses. However, recently several series have shown that properly selected patients can be treated by laparoscopic salpingo-oophorectomy. One potential concern with the laparoscopic approach is rupture of a malignant mass with resultant dissemination of malignant cells. The introduction of laparoscopic bags has greatly aided in the laparoscopic removal of ovarian neoplasms without intraoperative rupture. Currently laparoscopic tubal ligation is the most common approach, accounting for over 50% of procedures. With the advent of bipolar cautery, a lower incidence of bowel injury has been seen in comparison with unipolar technique.