ABSTRACT
The CO2 laser has been used intraabdominally in gynecological surgery (to preserve reproductive potential) for the past 6 years. Several publications describe its applications when coupled to an operating microscope (microlaser surgery) as well as on freehand laser laparotomy in animals and in humans (1-23). As surgical techniques have evolved with time, so have improvements in surgical laser delivery systems. In particular, the development of a closed-cube micromanipulator enables the articulating arm of the laser to be coupled to the laser laparoscope. This preservation of the pneumoperitoneum has enabled the gynecological laser surgeon to perform conservative pelvic surgery on an outpatient basis, which obviates the need for laparotomy (24-37). This new modality, laser laparoscopy, is useful in treating pelvic endometriosis, adhesions, selected cases of distal tubal occlusion, and small uterine myomas. The first use of the CO2 laser, aimed through the operating channel of the laparoscope, was reported by Bruhat in France in 1979 (25). In Israel, Tadir et al. (35) reported the use of the CO2 laser through a second-puncture laparoscope in 1981. Both Bruhat (25) and Tadir (35) investigated the use of the CO2 laser for tubal sterilization. They now both recommend against its use because of early tubal recanalization. Daniell and Brown (26) first reported the use of the single-puncture CO2 laparoscope for animal and human surgery in 1982, which was followed by the use of a second-puncture laser laparoscope in treating endometriosis and pelvic adhesions 326in humans (27). Recently, Daniell and Herbert (28) reported the following results after laser laparoscopic terminal salpingostomy: 75% patency rate, 24% term pregnancy rate—for those women who had undergone at least one previous tuboplasty. Term pregnancy rates have varied from 14-76% (24,25,32-36) depending upon the underlying disease treated with the CO2 laser laparoscope.
