Laparoscopic surgery is open surgery carried out through small incisions with enhanced magnification of the operative field. The advantages of a laparoscopic (or key hole) approach to the abdomen and pelvis have been well documented and include: a significant reduction in postoperative pain, length of stay, recovery time and adhesion formation. In children or adolescents this will result in a faster return to school and normal activities. Laparoscopic incisions are much smaller than a transverse incision and indeed a midline laparotomy. This reduction in wound visibility is especially important in children and adolescents who otherwise may be asked by contemporaries or a new partner about the reasons behind the scar. This will be especially distressing while coming to terms with the psychological impact of the diagnosis of an XY karyotype or an absent uterus.

The claimant presented with abdominal pain from the age of 18 years through to the age of 36 years. When she finally underwent a laparoscopy, she was found to have grade 4 endometriosis which had spread around her ovaries, colon and the wall of the abdomen. She underwent treatment, but as the endometriosis was so far advanced it could not be fully treated and it was alleged: i) it had been negligent to consider her symptoms to be related to irritable bowel syndrome (IBS) alone; ii) there had been a failure to consider a diagnosis of endometriosis earlier; iii) there had been a failure to perform a laparoscopy earlier, even though her symptoms remained unchanged after treatment.

Introduction

The first gynaecological reports for laparoscopy came from Hope in 1937 (Hope, 1937) on the diagnosis of extrauterine pregnancy but it was not until the 1970s that laparoscopic surgery started to become established (Semm, 1970). The introduction of good-resolution camera systems and the development of new surgical instruments have enabled the advancement of laparoscopic surgery. In addition, advances in technology have increased the safety parameters and enabled surgery to be performed more efficiently. These technological developments include the expansion of bipolar technology and the introduction of laser modalities, the harmonic scalpel and haemostatic stapling devices.

Originally laparoscopic surgery was referred to as minimally invasive surgery but it soon became apparent that the surgery was highly invasive but performed through small incisions, and hence the term minimal access surgery was coined. Minimal access surgery can be considered as an alternative procedure to the traditional operation; it aims to achieve the same end result as the traditional operation but is performed through small incisions. In hysteroscopic surgery, most laparoscopic procedures should aim to emulate the open operation, the only difference being the size of the incision. However, there may be modifications in the minimal access route as a result of the improved vision that it affords or the difficulty in emulating the open procedure. The perceived disadvantages of the laparoscopic route over the open route are the potential complications, the time to perform the operation and the cost.