[Advantages and disadvantages of celioscopic surgery in gynecology]

In the last decade, operative laparoscopy has been a break through in the practice of gynecology. Recent progress has been made with the development of cold light, appropriate atraumatic instrumentation, video-camera and CO2 laser. Laparoscopy provides access to the pelvis, allowing for diagnosis and treatment of a variety of pathologies. The most frequent indication is the treatment of ectopic pregnancy. Salpingotomy with tubal preservation, the procedure of choice for young women wanting to become pregnant, has been used in 88 cases. However, tubal preservation is not always possible (rupture of the ovarian tube, hemosalpinx), and sometimes not even advisable (inflammatory lesions, homolateral recurrence) and salpingectomy was necessary in 294 cases. Another indication for salpingectomy is painful chronic salpingitis, resulting from an undetected or ill-treated Chlamydia trachomatis infection: 84 cases. Infertility surgery is the second most important indication for laparoscopic procedure. The authors have performed salpingoovariolysis in 49 cases, neosalpingostomy in 34 cases and fimbrioplasty in 31 cases. Reproductive outcome at 18 months post-operatively was comparable to results following microsurgical techniques, with a rate of ongoing pregnancies of 53% for adhesiolysis and 27.7% for distal tuboplasties. Immediate opening of hydrosalpinges at the time of diagnostic laparoscopy allows for precise evaluation of the tubal mucosa, thereby establishing prognosis. Laparoscopy also allows for management or ovarian cyst, first explored to determine the absence of any sign of malignancy. In most cases, the cyst's contents and wall may be entirely removed by laparoscopy: 115 cases.(ABSTRACT TRUNCATED AT 250 WORDS)