eMedicine Specialties > Obstetrics and Gynecology > Gynecologic Surgery

Gynecologic Laparoscopy: Follow-up

Author: William W Hurd, MD, MSc, Professor of Reproductive Biology, Case Western Reserve University School of Medicine; Lilian Hanna Baldwin Chair in Gynecology and Obstetrics, Director, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Hospitals Case Medical Center
Coauthor(s): Tommaso Falcone, MD, FRCSC, FACOG, Chairman, Professor of Surgery, CCLCM of Case Western Reserve University, Department of Obstetrics and Gynecology, Cleveland Clinic Foundation; Howard T Sharp, MD, FACOG, Associate Professor, Department of Obstetrics and Gynecology, University of Utah School of Medicine; Chief, General Division of Obstetrics and Gynecology, University of Utah Medical Center; Vivian E Von Gruenigen, MD, Director of Robotic Surgery, University Hospitals Case Medical Center; Associate Professor of Reproductive Biology, Division of Gynecologic Oncology, Case Western Reserve University School of Medicine
Contributor Information and Disclosures

Updated: Nov 4, 2009

Future and Controversies

Laparoscopy continues to evolve as more sophisticated instrumentation allows a greater variety of procedures to be performed. In the past, many of these procedures would have been limited to laparotomy and would have required a prolonged recovery period. The risks and benefits of the procedures in many cases have not been fully evaluated. Some procedures, such as tubal ligation, ectopic pregnancy removal, and simple adhesion lysis, appear to be safely and efficiently performed laparoscopically. However, more complicated procedures still need to be evaluated to determine the safest, most cost-effective, and most efficient procedure.

Gynecologic oncology

The laparoscopic approach for potential gynecologic malignancies remains controversial.16 In cases of ovarian masses with low risk of malignancy, laparoscopy has become the approach of choice. In questionable cases, preliminary steps should be taken to stage the patient, including obtaining pelvic washings, inspecting the entire peritoneal cavity and pelvic structures, and biopsying suspicious lesions. Frozen section pathological evaluation can be obtained intraoperatively to diagnose or exclude malignancy.

In the case where a malignancy is unexpectedly diagnosed during laparoscopy, concern remains that spilling the contents of an ovarian malignancy into the abdominal cavity during removal might worsen the long-term prognosis. However, the patient's prognosis does not appear to be worsened as long as definitive treatment is not delayed and is carried out either immediately or within a matter of days.

Laparoscopy is used by some gynecologic oncologists for patients with known gynecologic malignancies to biopsy retroperitoneal lymph nodes and for second-look procedures to evaluate for residual tumors after chemotherapy. The unusual finding of tumor implantations at the trocar insertion sites has caused some investigators to consider whether or not some aspect of laparoscopy might promote tumor growth. Until the risk, benefits, and effects on long-term prognosis have been shown to be equal to laparotomy, the laparoscopic approach for known gynecologic malignancies will remain under close scrutiny.

Robotic laparoscopic surgery
The usefulness of robotics in laparoscopic surgery continues to be determined.5 The first FDA-approved robotic surgical device called AESOP (Automatic Endoscopic System for Optimal Positioning, Computer Motion, Inc, Santa Barbara, Calif) was introduced in 1994. This system allowed the surgeon to control the orientation of the laparoscope through voice commands.

The da Vinci Robotic Surgical System (Intuitive Surgical, Sunnyvale, Calif) and Zeus Robotic Surgical System (Computer Motion, Inc, Santa Barbara, Calif) were later introduced, allowing the surgeon to operate from a remote station with hand controls, providing increased dexterity and the ability to minimize fatigue, tremors, or incidental hand movement. In 2003, these companies merged.

The da Vinci System is widely used for cardiovascular, urologic, and gynecologic applications. Prospective studies have yet to be performed to determine the advantage of the robotic approach compared with less expensive traditional laparoscopic techniques for gynecologic surgery.

 


More on Gynecologic Laparoscopy

Overview: Gynecologic Laparoscopy
Workup: Gynecologic Laparoscopy
Treatment: Gynecologic Laparoscopy
Follow-up: Gynecologic Laparoscopy
Multimedia: Gynecologic Laparoscopy
References
Further Reading
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Further Reading

Hurd WW, Duke JM, Falcone T. Chapter 29. Gynecologic laparoscopy. In: Falcone T, Hurd WW, eds. Clinical Reproductive Medicine and Surgery, New York: Elsevier, 2007.

Sharp HT, Falcone T, Hurd WW. Chapter 40. Complications of laparoscopic surgery. In: Falcone T, Hurd WW, eds. Clinical Reproductive Medicine and Surgery, New York: Elsevier, 2007.

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Keywords

gynecologic laparoscopy, endoscopy, celioscopy, ectopic pregnancy, endometriosis, tubal ligation, laparoscopic gynecology, endometriosis, pelvic adhesion lysis, diagnostic laparoscopy, tubal fulguration, hysterectomy, incontinence procedures, gynecologic malignancy, bilateral tubal sterilization, BTL, adnexal torsion, pelvic pathology, gynecologic pathology

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Contributor Information and Disclosures

Author

William W Hurd, MD, MSc, Professor of Reproductive Biology, Case Western Reserve University School of Medicine; Lilian Hanna Baldwin Chair in Gynecology and Obstetrics, Director, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Hospitals Case Medical Center
William W Hurd, MD, MSc is a member of the following medical societies: Alpha Omega Alpha, American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American College of Physician Executives, American College of Surgeons, American Gynecological and Obstetrical Society, American Medical Association, American Society for Reproductive Medicine, Society for Gynecologic Investigation, and Society of Reproductive Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Tommaso Falcone, MD, FRCSC, FACOG, Chairman, Professor of Surgery, CCLCM of Case Western Reserve University, Department of Obstetrics and Gynecology, Cleveland Clinic Foundation
Tommaso Falcone, MD, FRCSC, FACOG is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, Association of Professors of Gynecology and Obstetrics, Society of Laparoendoscopic Surgeons, and Society of Reproductive Surgeons
Disclosure: Nothing to disclose.

Howard T Sharp, MD, FACOG, Associate Professor, Department of Obstetrics and Gynecology, University of Utah School of Medicine; Chief, General Division of Obstetrics and Gynecology, University of Utah Medical Center
Howard T Sharp, MD, FACOG is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Medical Association, and Utah Medical Association
Disclosure: Nothing to disclose.

Vivian E Von Gruenigen, MD, Director of Robotic Surgery, University Hospitals Case Medical Center; Associate Professor of Reproductive Biology, Division of Gynecologic Oncology, Case Western Reserve University School of Medicine
Vivian E Von Gruenigen, MD is a member of the following medical societies: Gynecologic Cancer Foundation
Disclosure: Intuitive Surgical Honoraria Surgical Proctor

Medical Editor

Thomas Michael Price, MD, Associate Professor of Reproductive Endocrinology, Director of Reproductive Fellowship Training Program, Duke University Medical Center
Thomas Michael Price, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, Phi Beta Kappa, and Society for Gynecologic Investigation
Disclosure: Clinical Advisors Group Consulting fee Consulting; MEDA Corp Consulting Consulting fee Consulting; Gerson Lehrman Group Advisor  Consulting fee Consulting; Roche/GSK Spokesperson  Consulting fee Consulting; Abbott Pharmaceuticals Grant/research funds PI; Adiana Grant/research funds PI

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Gail F Whitman-Elia, MD, Professor, Department of Obstetrics and Gynecology, University of South Carolina School of Medicine
Gail F Whitman-Elia, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Clinical Endocrinologists, American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, American Medical Women's Association, American Public Health Association, American Society for Reproductive Medicine, Endocrine Society, and South Carolina Medical Association
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

 
 
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