It is often difficult to tell which patients with acute abdominal pain will require surgery. We studied 79 patients with acute abdominal pain who were thought likely, though not unequivocally, to have abdominal problems requiring surgery. All underwent laparoscopy and only 27 subsequently required open laparotomies. The accuracy rate as determined by followup was 99%. The liberal use of laparoscopy for uncertain cases of appendicitis resulted in a negative appendectomy rate of only 2.2%. There were no deaths and no major complications.

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This article describes in detail a new approach to laparoscopic hysterectomy. It is based on understanding the vasculature of the uterus, cervix, and cardinal ligament. The result of this appreciation of the anatomy is a clean, logical, rapid, anatomic approach to hysterectomy not previously promoted. There is a dissectible, loose, fibrous plane that lies between the uterus and the portion of the uterine artery that courses up and down the side of the uterus. It is traversed by multiple small branches of the uterine artery, which are coagulated easily with monopolar coagulation current. By the dissection of this plane down the side of the uterus and cervix, the cardinal ligament can be peeled off the cervix. This allows a bloodless dissection well away from any risk of injury to the ureter. The anatomy and surgical technique are described for laparoscopic hysterectomy and laparoscopically assisted vaginal hysterectomy.