National trends in gynaecological endoscopic surgery.

Endoscopic or minimal access surgery promises less postoperative pain and decreased hospitalization. It is also a more reliable diagnostic tool than some conventional diagnostic procedures. The Medicare database was analyzed over 4 sequential financial years (1991-1992 to 1994-1995) to assess trends in utilization of endoscopic procedures in the private sector. Hysteroscopy is slowly replacing dilatation and curettage as a diagnostic procedure. Endometrial ablations are decreasing. A higher proportion of adnexal procedures and ectopic pregnancies are being managed endoscopically. Laparoscopically-assisted hysterectomies are slowly increasing. However data from the last 2 financial years suggests that the trend to endoscopic procedures is stalling with laparotomy still being extensively used. This may indicate an increased need for education and workshops by responsible organizations to extend the potential benefits of endoscopic surgery to more patients.