Most studies have suggested laparoscopic surgery is superior to laparotomy. Advantages of laparoscopy include shorter hospital stay, less surgical blood loss, less analgesia requirement and short post-operative convalescence. In year 2000 laparascopic surgery accounted for 40% of urologic procedures, 50% of general surgery procedures and 70% of gynaecologic procedures performed in United States. As no surgical procedure is without risk, survey of laparascopic complications in UK revealed an incidence of 1.4-4.7/1000 operative laparascopies. The American Association of Gynaecological Laparoscopists was founded in 1972 and since than complications have decreased from 78% in 1972 to as low as 12% in 1993. Hence improved training and credentialing can help ameliorate complications relating to improper technique.
Laparascopic management of ectopic pregnancies is accepted worldwide in haemodynamically stable patients. In our series the patient with 2000ml haemoperitoneum was haemodynamically stable. The presence of haemoperitoneum should not preculude laparoscopic treatment and utilizing a wide bore suction irrigator blood can be evacuated. Endovision camera with high gain, xenon light source, excellent telescopes and electronic carbon dioxide endoflator provide excellent visibility and surgeon's don't have to fish in dark.
Most patients with rheumatic heart disease after valve replacement have optimal cardiac functions and anaesthesia with cardiac monitoring and skillfully performed laparoscopy is advantageous over laparotomy.
Patients after laparotomy are discharged in two days and ability to resume normal activity is much better with laparoscopy.