Patients recovering from laparoscopic surgery usually experience daily improvement. Pain diminishes, gastrointestinal function returns rapidly, and fever is extremely unusual. Therefore, if a patient’s condition is not improving, possible complications of anesthesia or surgery should be considered.
Endoscopy is a procedure that uses a narrow telescope to view the interior of a viscus or preformed space. Although the first medical endoscopic procedures were performed more than 100 years ago, the potential of this method was realized only recently. Endoscopes are used to perform a variety of operations. In gynecology, endoscopes are used most often to diagnose conditions by direct visualization of the peritoneal cavity (laparoscopy) or the inside of the uterus (hysteroscopy).
When used appropriately, endoscopic surgery offers the benefits of reduced pain, improved cosmesis, lower cost, and faster recovery. The indications for endoscopic surgery are outlined here and described in more detail in the appropriate chapters. The technology, potential uses, and complications of laparoscopy and hysteroscopy are summarized here.
The past four decades have witnessed rapid progress and technologic advances in gynecologic laparoscopy. Operative laparoscopy was developed in the 1970s, and in the early 1980s, laparoscopy was first used to direct the application of electrical or laser energy for the treatment of advanced stages of endometriosis. The use of high-resolution, and, more recently, high-definition video cameras in operative laparoscopy made it easier to view the pelvis during the performance of complex procedures (1,2). Most procedures that previously were performed using traditional techniques are feasible with the laparoscope, including adnexal procedures such as ectopic pregnancy and ovarian cystectomy; uterine surgery, such as myomectomy and hysterectomy; and reconstruction of the pelvic ﬂoor, such as retropubic urethropexy and sacral colposuspension. The endoscopic approach may have drawbacks in some patients. Although many laparoscopic procedures appear to reduce the cost and morbidity associated with surgery, others were replaced by even less invasive procedures, and a few were not effective replacements for more traditional operations. The use of microprocessor-assisted laparoscopy allows the surgeon to operate remotely from the operative field, in a sitting position, with the “robot” allowing translation of natural hand manipulations to the peritoneal cavity with the specially designed instruments. The value of this and other techniques and indications for operative endoscopy are still under investigation and constantly in a state of evolution.
Diagnostic Laparoscopy The lens of a laparoscope can be positioned to allow wide-angle or magnified views of the peritoneal cavity. The clarity and illumination of the optics allow a better appreciation of fine detail than is possible with the naked eye. Laparoscopy is the standard method for the diagnosis of endometriosis and adhesions because no other imaging technique provides the same degree of sensitivity and specificity.