The Influence of Operative Laparoscopy on the General Operative Concept in Gynecology

At Caritas-Klinik St. Theresia, Saarbrucken, Germany, 1663 patients underwent gynecologic surgery between 1990 and 1993. In the same period therapy via laparotomy was replaced stepwise by operative laparoscopy. While operative laparoscopy amounted to 70% (n=316) of all operations in 1990, it was 87% (n=515) in 1993. Additionally, the positive experience with minimally invasive surgery permitted us to enlarge the spectrum of indications for operative laparoscopy considerably, so that extensive adhesiolysis within the entire abdominal cavity (n=78 in 1993), adnexal surgery in pre- and postmenopausal women (n=254 in 1993), and laparoscopic hysterectomy (n=71 in 1993) have become routine today. Morbidity of patients after operative laparoscopy was significantly lower than after laparotomy. Our experiences support the view that operative laparoscopy is not only a benefit to selected subgroups of patients but may be applied successfully to the majority of women requiring gynecologic surgery.