Laparoscopic surgery has been at the forefront of gynecologic surgical innovation in the past decade. Major benefits associated with the use of laparoscopy include a reduced size of surgical incisions, reduced length of hospital stay, increased use of outpatient surgery, a more rapid postoperative recovery period, reduced morbidity, and reduced total costs of treatment. Recent refinements in surgical technique and instrumentation have allowed new applications of laparoscopy with the potential to further realize each of these goals.

The performance of laparoscopy without general anesthesia is not a new concept. In fact, laparoscopy was initially developed as a local anesthetic procedure.<sup>1 Alexander G., Goldrath M., Brown E. , e al. Outpatient laparoscopic sterilization under local anesthesia Am J Obstet Gynecol 1973 ;  116 : 1065-1068

Cliccare qui per andare alla sezione Riferimenti, 8 Fishburne J., Omran K., Hulka J. , e al. Laparoscopic tubal clip sterilization under local anesthesia Fertil Steril 1974 ;  25 : 762-766

Cliccare qui per andare alla sezione Riferimenti, 9 Gunning J. The history of laparoscopy J Reprod Med 1974 ;  12 : 222-226

Cliccare qui per andare alla sezione Riferimenti, 25 Peterson H., Hulka J., Spielman F. , e al. Local vs. general anesthesia for laparoscopic sterilization: Randomized study Obstet Gynecol 1987 ;  70 : 903-908

Cliccare qui per andare alla sezione Riferimenti, 32 Short A. The use of celioscopy BMJ 1925 ;  2 : 254  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 35 Wheeless C. Outpatient laparoscopic sterilization under local anesthesia Obstet Gynecol 1972 ;  39 : 767-770

Cliccare qui per andare alla sezione Riferimenti</sup> Over the past 75 years, laparoscopy has gradually shifted to a procedure primarily performed under general anesthesia. This transformation in anesthetic technique has necessitated that the procedure be performed in a traditional operating room (hospital or outpatient surgical center). Unfortunately, this degree of resource use, including a full operating room, anesthesiologist and general anesthesia, and full postoperative recovery room, is in excess of what is required for simple diagnostic laparoscopy. During the same time frame, colonoscopy and cystoscopy have been transformed to procedures primarily performed in outpatient procedure rooms under local anesthesia. The overall concept is to use an appropriate level of resources for each procedure and to avoid the overuse of resources that are not required. Older protocols for local anesthetic laparoscopy have been modified by the technologic innovation of microlaparoscopy (using instruments less than 5 mm in diameter), which has raised patient tolerance and lengthened the time during which procedures can be performed (increasing the likelihood of adequate and complete examinations).

The technique of office laparoscopy performed with the patient under local anesthesia is especially suited to meet the current pressures of quality versus cost in an era of managed care. It is likely that this technique will soon become a major part of the practicing gynecologist's diagnostic and operative armamentarium. Advantages of office microlaparoscopy under local anesthesia are realized by the practitioner, the patient, and the managed care provider. Patients benefit from decreased scheduling delays, a more rapid postoperative recovery with decreased pain, decreased total procedure costs, and a greater involvement in the procedure. Physicians benefit from a greater control over the scheduling of the procedure, the potential to perform laparoscopy in a traditional office procedure room, and streamlined care delivery. All of this translates into reduced total costs, deceased disability, a more rapid return to the workforce, and greater total satisfaction.