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.

Authors:

Harry Reich, M.D., Wyoming Valley Healthcare Systems, Wilke's-Barre, PA, Thierry G. Vancaillie, M.D., Center for Gynecologic Endosurgery, San Antonio, TX

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