Abstract

PIP: Laparoscopy is reviewed in this keynote lecture of the 1st annual meeting of the American Association of Gynecological Laparoscopists in Las Vegas, Nevada, November 1972. The pneumoperitoneum may produce pressure on the inferior vena cava and stomach and cause splinting of the diaphragm leading to impaired ventilation, reduction in venous return to the heart, and possible regurgitation of stomach contents. Absorption of carbon dioxide may cause a rise of partial pressure of carbon dioxide with associated cardiac arrhythmias. All of these problems are controlled or prevented by a general anesthetic with intubation by a cuff tube, good muscle relaxation, and controlled ventilation by a respirator. Laparoscopy may be used to determine intact ectopic pregnancy and study female sterility, early endometriosis, acute salpingitis, chronic pelvic inflammatory disease, small uterine or other masses, and primary and secondary amenorrhea. Surgical uses include puncture and/or aspiration of ovarian cysts or tubo-ovarian cysts, removal of foreign bodies, resection of adhesions, tubal sterilization, and ventrosuspension of uterus. Contraindications include difficulty in establishing an adequate pneumoperitoneum; acute peritonitis, ileus, or intestinal obstruction; and inadvisability of penumoperitoneum or Trendelenburg position. Laparoscopy can diagnose the extent and nature of pelvic and abdominal cancer and evaluate treatment. Reported complications with laparoscopy include puncture of vessels, perforation of intra-abdominal viscus, parietal or omental emphysema, cardiorespiratory embarrassment, and effects of high-pressure gas injections. A woman infertile due to absent or useless oviducts but with a healthy uterus and at least 1 healthy functioning ovary could seemingly be assisted through recovery of oocytes via laparoscopy, fertilization and cleavage of the ovum in vitro, and finally embryo transfer into her uterus. The first 2 steps have already been accomplished for women.