Open laparoscopy. Commentary

Open laparoscopy has been receiving increased attention in the US and internationally. However, opinions differ on its appropriate role in laparoscopy services. In the US some surgeons remain comfortable using closed laparoscopy for all patients, including some who have had previous abdominal surgery. Some centers are using more open procedures, especially for training programs and for cases where open laparoscopy may be indicated, as described by Dr. Hasson in this "Bulletin." Others have converted to performing all laparoscopy by the open technique. The Planned Parenthood Federation of America encourages minilaparotomy and open laparoscopy for tubal occlusion n its facilities because of the greater inherent potential for patient safety with these approaches. AVS has not provided open laparoscopy equipment to international programs, although some projects have used an open technique. Neither the World Federation of Health Agencies for the Advancement of Voluntary Surgical Contraception nor the AVS Science Committee has addressed the role of open laparoscopy in international programs. This is due in part to insufficient worldwide experience in open laparoscopy. However, this does not preclude AVS from providing such equipment for open laparoscopy in the future. In the US approximately 300-500 Hasson cannulas have been commercially distributed annually for the past 4-5 years. About 2000 may be currently in use in the US. Therefore, among the 6915 hospitals registered with the American Hospital Association in 1982, a substantial proportion may now provide access to open laparoscopy equipment. Studies in the US are not yet available to fully assess the safety of open laparoscopy. However, general comparisons of complication rates for open and closed laparoscopy may not be appropriate since many surgeons reserve the more complicated cases for open laparoscopy.