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EDITORIAL COMMENT: This and the following paper described further modifications of laparoscopic techniques for gynaecological surgery. It has always been standard teaching at laparotomy to mobilize endometriotic ovaries adherent to the broad ligament and other peritoneal structures by blunt dissection with the finger pressed against the back of the uterus and broad ligament. Experience has shown that this is much safer than dissection in situ and less likely to cause haemorrhage or damage to other structures such as rectum and ureter. To the nonlaparoscopist writer of this comment it appears that this minilaparotomy technique retains this classical method of mobilization of the ovaries and possibly it is not only quicker but safer than dissection via the laparoscope! Summary: In a preliminary study the principles of standard gynaecological surgery, new operative laparoscopic techniques and mechanical elevation of the abdominal wall are combined. These early results indicate an advantage to both patient and hospitals from this approach. Further studies are required to verify our impressions that minilaparotomy combined with no insufflation laparoendoscopy will open up the concept of operative laparoscopic surgery to most gynaecologists.
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