[The evolution of the indications for laparoscopy between 1973 and 1977. 1,758 cases (author's transl)]

Abstract

In order to avoid the misuse of laparoscopy by an unnecessary increase in the indications for the procedure the authors have reviewed the evolution of these indications in the five years between 1973 and 1977. Certain indications have stayed stable, such as chronic pain in the pelvis, masses found in the pelvis, symptoms suggestive of upper genital tract infection or of ectopic pregnancy and tubal or unexplained sterility. Stability in these indications is correct because laparoscopy and laparoscopy alone can give a precise diagnosis of the lesion and complete the clinical findings and the other methods of investigation. There are two indications which have become less frequent and these are: ovarian sterility and amenorrhoea. This is logical since more reliance has come to be placed on biological methods. Laparoscopy should be reserved in these conditions for cases where are contradictions between biological findings or where there are therapeutic failures. An increase in the indications which is very justified is in those laparoscopies which are carried out as a control of the results of tubal surgery, because there a prognosis can be given and therapy can be carried out (such as division of adhesions) and in cases of malignant tumours of the ovary which, although the procedure will give less precise information than laparotomy, has the advantage that it can be repeated from time to time.

PIP: The article presents a review of the evolution of indications for laparosocpy during the years 1973-1977. Laparoscopy is always indicated in case of chronic pelvic pains, ovarian malignant tumors, tubal infertility, adnexitis or ectopic pregnancy. In such cases the accurate inspection of the pelvic cavity can allow precise diagnosis and therapy. Laparoscopy can also be repeated to control the effectiveness of therapy, especially in the surveillance of ovarian cancers. On the other hand, laparoscopy should not be systematically performed in cases of isolated pelvic pains, in case of ovarian cyst or fibroma, or in case of amenorrhea, where clinical examinations and biological explorations are sufficient to determine diagnosis and therapy. Laparoscopy should be used only when there are contraindications among biological findings, or in cases of therapeutic failures.