Is It Really a Surgical Advance? (Guest Editorial).

The jury is still out on whether laparoscopic correction of incontinence and prolapse is truly a surgical advance.

Although the laparoscope was introduced into gynecology decades ago as a diagnostic tool, it is now being promoted as a means of treatment as well. With the current explosion in minimally invasive surgery and rapid advances in pelviscopy, many gynecologic surgeons are being challenged to attempt certain procedures laparoscopically that historically have only been accomplished through laparotomy.

With few clinical trials comparing laparoscopic procedures with conventional open procedures, the true risks and benefits of operative laparoscopy are unknown.

In addition, as with any new procedure, there is a significant learning curve in which complications are more likely to occur early in the surgeon's experience.

Added to this is another worrisome phenomenon-gynecologic surgeons who are technically good laparoscopists moving into the field of urogynecologic surgery without the necessary understanding of pelvic floor anatomy and the continence mechanism. Take, for example, the retropubic colposuspension. The goal of this surgery is to stabilize the urethrovesical junction in a retropubic position, thus preventing its descent during rises in intra-abdominal pressure.

It is well documented that this procedure can be performed via a laparotomy with good long-term success and minimal morbidity. To replace this proven approach with a laparoscopic technique, the surgeon should feel confident that there will be comparable efficacy and that complication rates will be equivalent or better. To date, however, there have only been a few reports on the laparoscopic approach. These were studies with minimal follow-up that were conducted by physicians with extensive laparoscopic experience.

The claimed advantages of the laparoscopic approach are shorter hospitalization, better cosmetic results, less morbidity, and a shorter immediate ...