Frontiers of operative laparoscopy: a review and critique of the evidence.
OBJECTIVE
This report reviews the evidence supporting the use of operative laparoscopy for a number of expanded indications in gynecology.


METHODS
Studies published in English were identified through a Medline search back to 1966 for literature listed under the medical subject heading of "peritoneoscopy"; this search was supplemented by reviews of reference lists and discussions with experts.


RESULTS
Fair evidence exists to recommend use of laparoscopy for ectopic pregnancy, ovarian biopsy, and treatment of polycystic ovarian syndrome resistant to clomiphene citrate therapy. Evidence concerning other indications is inadequate to allow recommendations.


CONCLUSIONS
Mechanisms are urgently needed to evaluate surgical innovations in gynecology with the same degree of scientific rigor currently afforded medical innovations. Without surgical technology assessment, the current double standards in gynecologic therapy will persist.
Grimes
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DA
Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles.
D000038:Abscess / Q000601:surgery; D000290:Adnexa Uteri / Q000601:surgery; D001706:Biopsy / Q000379:methods; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D053685:Laser Therapy / Q000379:methods*; D019635:Neurosurgical Procedures; D010048:Ovarian Cysts / Q000601:surgery; D010053:Ovary / Q000473:pathology; D010388:Pelvis / Q000601:surgery; D011085:Polycystic Ovary Syndrome / Q000601:surgery; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000601:surgery; D014599:Uterus / Q000294:innervation