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Office operative endoscopy in infertility

International Congress Series
Publication Date
DOI: 10.1016/j.ics.2004.01.111
  • Office Endoscopy
  • Hysteroscopy
  • Transvaginal Endoscopy
  • Endometriosis
  • Ovarian Drilling
  • Law
  • Medicine
  • Political Science


Abstract The implementation of ambulatory surgical procedures in endoscopic surgery has been inspired by several coincidental factors. First, there is a necessity to reduce the cost of interventions because of government restrictions on payments, and second, there is a general trend to reduce the invasiveness of endoscopic procedures, thus pushing companies to develop smaller endoscopes without loss of optical quality. At present, however, confusion exists between the concepts of minimal invasive surgery and minimal access surgery. As accuracy of smaller-diameter endoscopes with very high optical quality is comparable with that of larger endoscopes, surgeons were inspired to use less-invasive surgery and to use smaller instruments. As a result, performing diagnostic procedures and minor interventions under local anaesthesia became possible and was widely accepted. Despite these advances, ambulatory surgery must not diminish the quality of care for patients. In particular, the use of the term ‘office laparoscopy’ can create some confusion in countries outside the US. Many so-called “office settings” in the US have fully equipped operating theaters and, although located outside a hospital setting, they tend to be situated closely to a hospital. For the patient's benefit and also for medico-legal reasons, full laparoscopies have to be performed in a fully equipped operating theater. Ambulatory surgical procedures must offer patients the requirements of classical surgery in terms of safety and quality. A 1-day clinic setting reduces the costs of hospitalization while, at the same time, minimal invasiveness will result in a low morbidity with a faster resumption of normal professional or home activities. Certainly in reproductive surgery, these are important issues, as we are dealing with healthy patients who dislike frequent interruptions to their daily activities. As such, patients are trying to conceive as soon as possible, a minimal invasive approach with a maximal conservation of their reproductive potential is mandatory. Ambulatory reproductive surgery involves both uterine and tubo-ovarian interventions.

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