Critical Decisions in 22 Years of Outpatient Laparoscopy

More than 2400 single-incision outpatient laparoscopic operations for sterilization or diagnosis performed by the author over the past 22 years have been influenced by seven critical decisions which were made after reviewing all of the options: 1. Perform procedures on all cooperative patients in free-standing facilities, except in cases with serious medical disorders which require elaborate safeguards and the presence of an anesthesiologist. 2. Administer local anesthesia in all cases. 3. Use the Hasson cannula with blunt obturator for open abdominal entry in every case. 4. Abandon tubal coagulation for sterilization. Instead, perform mechanical tubal occlusion with the Hulka-Lexan Clip. 5. Instill low-volume filtered room air for pneumoperitoneum in place of nitrous oxide. 6. Enter the abdomen through the umbilical fossa in all obese women instead of through the lower rim of the umbilicus. 7. As preliminary steps in abdominal entry in every patient, perforate the partially incised fascia and the parietal peritoneum with a small Kelly clamp or hemostat instead of a scalpel. Each of these seven decisions has, in the author's opinion, improved the technique and safety of outpatient laparoscopy.