Technical progress in pelvic surgery via operative laparoscopy.

The development of an optimal set of instruments for perfect grasping, cutting, sucking, and ligating and of a new system to perform hemostasis by endocoaguation through a trocar sheath 7 to 11 mm in diameter permits effective laparoscopic surgery. A total of 2,000 operative laparoscopies were performed safely between 1973 and 1976. Since 1977, laparoscopic surgery has been extended to the following procedures: myomectomy (subserous), adnexectomy, ovarian cyst resection, removal of a cystoma, and tubectomy in cases of tubal pregnancy. In 82 such cases, no intraoperative or postoperative complications occurred. The normal postsurgical healing procedure has been checked during 18 second-look laparoscopies and two consecutive laparotomies. These technical advances have opened up a new era of gynecologic surgery based on operative laparoscopy.