Abstract

What role could laparoscopy possibly play in treatment of uterine disorders and pelvic floor relaxation? The basic principle that laparoscopy is a mode of access, not a mode of treatment, must be emphasized. Statements such as "laparoscopic treatment of genuine stress urinary incontinence" are misleading because they imply that laparoscopy is a treatment modality, which it isn't. Laparoscopy provides only access to the anatomical area. Theoretically any procedure classically done at laparotomy, can be done under laparoscopic control. Is executing such procedures self gratification for the surgeon or a benefit for the patient? No doubt, procedures performed under laparoscopic control require more surgical skill. The benefits for the patient are reduced need for analgesia, which means that the procedure is significantly less painful, less postoperative ileus, reduced length of hospital stay, and finally, reduced cost to society through both direct and indirect savings. The fact that the procedure is less painful is reason enough to eliminate laparotomy in favor of laparoscopy: "Dolor per primam" is part of Hippocrates' oath.

Abstract

Tubotubal anastomosis technique dates back to the 1920's when large sutures were used to approximate proximal and distal ends of the fallopian tube. Direct vision, aided by overhead illumination, was used and stitches were placed superficially to avoid inclusion of the posterior wall. Delicate tissue handling was not stressed. No major breakthroughs in this area developed over the next half century. The 21% success rate for the conventional technique was disappointingly low although a clear explanation has never been established. Presumably it was caused either by the failure to reconstruct a patent lumenal channel or by causing extensive postoperative adhesion formation.

Abstract

As with other organs, the etiology of bowel endometriosis is unknown. Its occurrence was reported as early as 1922 by Sampson. Following his investigation of nineteen cases, he proposed that "implantation adenoma of endometrial type of some portion of the intestinal tract may be present in at least one half of the cases of perforated ovarian hematoma of endometrial type with peritoneal implantations.

Abstract

Presacral neurectomy (PSN) has been successfully used to treat women experiencing midline premenstrual and menstrual dysmenorrhea along with midline pelvic pain for almost 100 years. Recent developments in minimally-invasive surgical technique have allowed the gynecologic surgeon to perform laparoscopic presacral neurectomy (LPSN) as an isolated procedure or in conjunction with other conservative procedures for the treatment of pelvic pain and dysmenorrhea.