The role of laparoscopy in intrauterine insemination: a prospective randomized reallocation study. ... METHODS: In a randomized controlled trial, the accuracy of a standard laparoscopy prior to IUI was compared with a laparoscopy performed after six unsuccessful cycles of IUI.
Emergency laparoscopic surgery allows both the evaluation of acute abdominal pain and the treatment of many common acute abdominal disorders. This review critically evaluates the current evidence base for the use of laparoscopy, both diagnostic and interventional, in the emergency abdomen, and provides guidance for surgeons as to current best practise. Laparoscopic surgery is firmly established as the best intervention in most gynaecological emergencies.
Many acute gynaecological disorders can be diagnosed and treated via laparoscopy. In gynaecological emergencies CT scanning is rarely helpful, and usually a combination of pregnancy testing, clinical acumen and trans-vaginal (TV) and trans-abdominal (TA) scanning are utilised to formulate a differential diagnosis. Following these conventional investigations, diagnostic laparoscopy is highly effective and recommended. There is a significant amount of high quality evidence regarding the role of laparoscopic surgery in ectopic pregnancy (EP). In confirmed EP, laparoscopy should be performed unless haemodynamic instability is present. It is fast, cheaper, and fertility outcome is comparable to laparotomy. Furthermore, hospitalization and sick leave times are shorter, and adhesion development reduced when compared to laparotomy. If tubal rupture has occurred, a laparoscopic salpingectomy should be performed. However, in cases of unruptured tubal pregnancy, a tube preserving operation should be considered. Ovarian cyst torsion is an organ threatening condition that causes patients to present with acute lower abdominal pain. Initially, pregnancy must be excluded, and a TV scan performed to exclude ovarian cyst formation. If pain fails to settle, a laparoscopy must be performed to exclude adnexal torsion. Any ovarian cysts found during laparoscopy can be treated laparoscopically. Laparoscopic surgery to repair ovarian torsion is superior to open and is suitable even in pregnancy. Salpingo-oophoritis commonly causes acute pelvic and lower abdominal pain, and can mimic other surgical diagnoses. Diagnostic laparoscopy can be useful to exclude other common pathologies. If the diagnosis is correct, microbiological samples can be taken to target anti-microbial therapy, and in pyosalpinx, pus can be drained laparoscopically. In conclusion, if gynaecological disorders are the suspected cause of pain, diagnostic laparoscopy should be performed, as frequently simultaneous therapy will be possible.