Results of microsurgical treatment of tubal infertility and early second-look laparoscopy in the post-pelvic inflammatory disease patient: implications for in vitro fertilization

Sixty-nine patients with tubal infertility secondary to pelvic inflammatory disease were surgically treated by one of three infertility surgeons, who used microsurgery for repair of the tubal pathologic condition and early second-look laparoscopy 6 to 30 days postoperatively for lysis of postoperative adhesions. No patient was included in this group whose disease was thought to have originated from endometriosis or prior abdominal surgery. The average follow-up time was 43.1 months (range 12 to 85.9). Nine patients were excluded from the analysis. Pregnancy outcome by procedure, expressed as the percentage of patients conceiving, was as follows: adhesiolysis, 69% (61% term, 8% ectopic); fimbrioplasty, 35% (25% term, 10% ectopic); salpingostomy, 30% (18% term, 12% ectopic); and cornual implantation, 60% (40% term, 20% ectopic). No added therapeutic value could be attributed to the use of early second-look laparoscopy. Given the relatively poor outcome of fimbrioplasty and salpingostomy, it may be prudent to advise patients with bilateral partial and/or total tubal occlusion against tuboplasty in favor of in vitro fertilization and embryo transfer.     

生育镜在不孕症诊治中的应用

目的探讨生育镜用于不孕症诊治的价值。方法用生育镜[包括经阴道注水腹腔镜（THL）与宫腔镜]对115例不孕症患者进行盆腔检查,观察内容包括输卵管通畅性、盆腔粘连情况等,以及盆腔完全评价率（即盆腔器官是否能被生育镜全部观察到）及术中、术后并发症。同时行THL下输卵管通液术和宫腔镜下输卵管口插管通液术。穿刺套管针成功从后穹窿穿刺入子宫直肠陷凹110例,其中原发性不孕（原发组）49例,继发性不孕（继发组）61例。既往输卵管检查为双侧阻塞者,原发组21例,继发组22例。结果术后输卵管双侧或一侧通畅者原发组34例（69．4％,34／49）,继发组42例（68．9％,42／61）,两组比较,差异也无统计学意义（P〉0．05）;既往输卵管检查为双侧阻塞者,术后双侧或一侧输卵管通畅者原发组10例（47．6％,10／21）,继发组11例（50．0％,11／22）,两组比较,差异无统计学意义（P〉0．05）。盆腔粘连者原发组21例（42．9％,21／49）,继发组37例（60．7％,37／61）,两组比较,差异无统计学意义（P〉0．05）。两组总的盆腔完全评价率为69．1％（76／110）,其中原发组为77．6％（38／49）,继发组为62．3％（38／61）．两组比较,差异无统计学意义（P〉0．05）。术后需行常规腹腔镜手术者20例（18．2％,20／110）,原发组与继发组分别为4例（8．2％,4／49）和16例（26．2％,16／61）,两组比较,差异有统计学意义（P〈0．05）;其中17例接受了微型腹腔镜手术。术中无盆腔脏器损伤、出血、直肠损伤或穿孔,术后无穿刺部位出血及盆腔感染等并发症发生。结论生育镜用于不孕症的诊治,操作简单、微创、安全、患者依从性好;对于临床或超声检查均无明显盆腔疾病证据的不孕症患者,生育镜可以取代经腹腹腔镜,成为一步到位的盆腔检查方法。     

Second-look laparoscopy after ectopic pregnancy

During the 4-year period of 1984 to 1987, 102 women with ectopic pregnancy (EP) underwent second-look laparoscopy 6 to 10 weeks after EP surgery. Benefits of this procedure, e.g., adhesiolysis and/or selection of women for further fertility interventions (in vitro fertilization [IVF], gamete intrafallopian transfer [GIFT], tubal microsurgery), were evaluated. On the basis of the second-look laparoscopy, 13% of the women were offered tubal microsurgery and 14% recommended for IVF. Patients without risk factors for EP developed adhesions as frequently as those with known risk factors and no specific surgical procedure was correlated to impairment of the pelvic status. Almost 40% of the patients presented with an impairment of adhesions on the affected side compared with the status at the time of EP surgery. Lysis of adhesions was performed during the second-look laparoscopy in 42 patients (41%). We conclude that second-look laparoscopy should be recommended to all EP patients with a desire for pregnancy.     

Second-look operative laparoscopy 1 year following reproductive surgery

To evaluate the efficacy of a second-look operative laparoscopy following a reproductive surgery, a randomized study was conducted on women who failed to conceive 1 year following terminal salpingostomy or following salpingo-ovariolysis by laparotomy. There is no significant difference in the cumulative probability of pregnancy at 12, 24, and 36 months follow-up between women who underwent second-look operative laparoscopy 1 year after salpingo-ovariolysis (27%, 67%, and 67%) and women who were continued to be observed expectantly (27%, 45%, and 52%, respectively). The cumulative probability of conception at 12, 24, and 36 months follow-up in women who underwent second-look laparoscopy 1 year after salpingostomy was 6%, 18%, and 18% and in women who were observed expectantly was 5%, 21%, and 27%, respectively (P = no significant). The incidence of ectopic pregnancy which was high (about one-half of patients who conceived) was also not affected by this procedure. This study suggests that second-look operative laparoscopy 1 year after terminal salpingostomy or salpingo-ovariolysis does not increase the pregnancy rate or decrease the incidence of ectopic pregnancy. Women who fail to conceive 1 year after a reproductive surgery still maintain some of their reproductive potential, but the risk of having an ectopic pregnancy is high.     

Hysterosalpingography versus laparoscopy in tubal infertility: comparison based on findings at laparatomy

One hundred ten infertile women underwent hysterography (HSG) and laparoscopy at the Obafemi Awolowo University, Nigeria. Both techniques showed normal tubal patency in 62 (56.4%) women and abnormal pelvic pathology in 48 (43.6%). All 48 women underwent laparotomy for tuboplasty. At laparotomy, HSG and laparoscopic assessments were compared. Both techniques were comparable in the diagnosis of intratubal and distal tubal occlusion. However, laparoscopy was superior in the diagnosis of non-tubal factors and proximal tubal occlusion (P less than 0.002). It is suggested that laparoscopy should be the first procedure in the investigation of tubal infertility and only followed by HSG if the results show some abnormality.     

Hydrosalpinx – Salpingostomy,salpingectomy or tubal occlusion

Tubal factors account for approximately 25% of cases of infertility, and the most severe manifestation of tubal disease is hydrosalpinx, accounting for 10–30% of tubal diseases. Hydrosalpinx is a distension or dilatation of the fallopian tube in the presence of a distal tubal occlusion, and the most common cause is pelvic inflammatory disease. Women with hydrosalpinges have lower implantation and pregnancy rates in assisted reproductive technology (ART), due to a combination of mechanical and chemical factors thought to disrupt the endometrial environment. Current guidance is removal of the tube by salpingectomy (preferably laparoscopically) before IVF treatment. Salpingostomy, or distal tubal plastic surgery in the management of hydrosalpinx, is an alternative for women desiring natural conception, although ectopic pregnancy rates as high as 10% have been reported. Proximal tubal occlusion with Essure^® devices placed hysteroscopically can be considered particularly in cases of distorted pelvic anatomy or pelvic adhesions making abdominal surgery complex. However, low clinical pregnancy and live birth rates have been reported with the use of these devices before IVF. In this review, we discuss salpingostomy, salpingectomy and tubal occlusion as possible management options for the reproductive women with hydrosalpinx.     

Effect of acute pelvic inflammatory disease on fertility.

A total of 415 women treated for laparoscopically verified pelvic inflammatory disease (PID) were reviewed after 9.5 years. Of these, 88 (21.2 per cent) were involuntarily childless after one or more infection; in 72 cases (17.3 per cent) this was due to tubal obstruction; 263 (63.4 per cent) women became pregnant; 64 (15.4 per cent) were voluntarily childless. Tubal occlusion was diagnosed after one infection in 12.8 per cent, after two infections in 35.5 per cent, and after three or more infections in 75 per cent of the women. Tubal occlusion was more common after nongonorrheal than after gonorrheal salpingitis. Infertility varied with the inflammatory changes seen at laparoscopy. The ratio between ectopic and intrauterine pregnancies after the infections was 1/24. Chronic abdominal pain was reported by 18.1 per cent of the women. Corresponding findings in 100 healthy control subjects were: involuntary childlessness in three despite normal Fallopian tubes, one ectopic in 147 intrauterine pregnancies, and chronic abdominal pain in five cases.     

Peritoneal fluid and serum leptin concentrations in women with primary infertility

Aim  Leptin is proposed to participate in the reproductive system of women by acting on either ovaries or hypothalamic-pituitary axis. The objective of the present study is to investigate the leptin concentrations in peritoneal fluid and serum samples of women diagnosed with primary infertility. Methods  A prospective study was carried out in women who underwent laparoscopy within the diagnostic process of primary infertility between January 2005 and January 2007. Leptin concentrations were determined in blood samples obtained before surgery and in peritoneal fluid samples collected during laparoscopy. Results  Peritoneal fluid was obtained from 112 subjects; 21 with unexplained infertility 28 with polycystic ovary syndrome (PCOS), 30 with bilateral tubal occlusion, and 33 with endometriosis. Subjects with PCOS have significantly higher body weights, BMI values and plasma leptin levels when compared to other study groups. Peritoneal fluid levels of leptin were significantly higher in the endometriosis group compared to other three study groups. A positive correlation was found between peritoneal fluid leptin levels and the endometriosis stage (r = 0.51, P = 0.01). However, plasma leptin levels were unrelated to the disease extent. Discussion  It might be hypothesized that leptin may be an active factor in the pathogenesis of PCOS and endometriosis, which are two major causes of primary infertility. A mild leptin deficiency in peritoneal environment may interrupt follicular development and ultimately lead to PCOS. Leptin has angiogenic and mitogenic properties, which trigger inflammatory cytokines and eventually result in the development of endometriosis implants. Significantly, higher levels of leptin in peritoneal environments of endometriosis subjects strongly imply the important role of this common pathology.     

Temporary ovarian suspension at laparoscopy for prevention of adhesions

We performed an innovative technique of temporary ovarian suspension after operative laparoscopy for stage 3 and 4 endometriosis and evaluated the results in a retrospective study. Subjects were 20 women who underwent operative laparoscopy for infertility. Temporary ovarian suspension to the anterior abdominal wall was performed as the last step in the surgical procedure. It was done in an attempt to separate adhesiogenic surfaces during the initial phase of tissue healing (5-7 days). No complications occurred. After excluding patients who had additional infertility factors and/or were of advanced reproductive age, nine women tried to conceive spontaneously. Of these, five conceived (55%): three delivered, one pregnancy continues (80%), and one woman had an ectopic pregnancy (20%). Of the remaining 15 patients who failed to conceive spontaneously, 5 had a second-look laparoscopy. In four patients (80%), we found no evidence of recurrent adhesions. The remaining 20% had minimal adhesions. Temporary ovarian suspension appears to be simple and safe, and may be effective in preventing postoperative adhesions near the ovaries after operative laparoscopy for advanced endometriosis.     

Laparoscopy in the "normal" infertile patient: a question revisited

STUDY OBJECTIVE: To determine the prevalence of reproductive pathology in a group of infertile women thought to be at low risk for altered pelvic anatomy. DESIGN: Retrospective chart review and follow-up (Canadian Task Force classification II-2). SETTING: Academic-affiliated, private reproductive endocrinology practice. PATIENTS: One hundred infertile women. INTERVENTION: Diagnostic and/or therapeutic laparoscopy. MEASUREMENTS AND MAIN RESULTS: Of 100 patients with a negative reproductive work-up up to the point of laparoscopy, 68 had pathology of reproductive significance: intrinsic tubal disease 24, peritubal adhesive disease 34, and endometriosis 43, some in combination. Laparoscopy was especially helpful in establishing treatment protocols for older women, who were referred for assisted reproductive techniques earlier than otherwise might have been the case. Women conceived after hormone therapy and after operative intervention. Although the hysterosalpingogram was read as normal in all women, tubal disease was diagnosed laparoscopically, independent of endometriosis, in 27 patients, with 2 having complete obstruction. Endometriosis stage I-II was found in 22 patients, stage III in 13, and stage IV in 6. CONCLUSION: Even in women thought to be at low risk for significant pelvic pathology affecting reproduction, the yield was high. Although some pregnancies were achieved after operative intervention, frequently laparoscopy was helpful in making a decision to go to assisted reproductive technology, particularly when infertility had been of long duration and in older women. Frequently the degree of pathology was such that a full operating suite was necessary to provide adequate instrumentation and anesthesia for operative intervention, which would not have been the case with office laparoscopy.     

Organ preserving endosurgery in pyosalpingitis]

Pyosalpinges are a difficult therapeutic problem in a complicated pelvic inflammatory disease. To avoid a diffuse peritonitis, often a laparotomy with salpingectomy is performed. 20 women of reproductive age with a uni- or bilateral pyosalpinx were incorporated in a prospective study to investigate the possibilities of a combined endosurgical/antibiotical treatment. After endoscopic confirmation, the patients were taken into study. During diagnostic laparoscopy, a salpingotomy with rinsing of the tubes and a drainage of the Douglas pouch took place. After one week of antibiotic treatment, a second-look laparoscopy was performed in all patients; no recurrence was documented. The combination of endosurgery and chemotherapy showed to be a safe and efficient therapy of tubal abscesses in women of reproductive age.     

腹腔镜和宫腔镜在不孕症诊治中的应用

本文对320例不孕症患者行腹腔镜检查,其中47例同时行宫腔镜检查及治疗。腹腔镜检查结果表明,盆腔炎症和子宫内膜异位症是本组病例中最常见的病因,占77.5％,由此引起的盆腔粘连和输卵管阻塞占71.33％,而这些病例56.9％(110/255)没有临床表现,因此腹腔镜检查是诊断盆腔炎和子宫内膜异位症的可靠方法。47例宫腔镜检查发现异常占21.3％,其中27例49条阻塞输卵管在宫腔镜下加压通液及行插管术,其中8例11条输卵管通畅,占29.6％,4例妊娠。因此对HSG或腹腔镜检查发现的输卵管阻塞,特别是近端阻塞,可在腹腔镜监视下,行宫腔镜加压通液或输卵管插管再通术以减少误诊。     

Should laparoscopy be a mandatory component of the infertility evaluation in infertile women with normal hysterosalpingogram or suspected unilateral distal tubal pathology?

OBJECTIVE: To assess the diagnostic benefit of laparoscopy in infertile women with normal hysterosalpingography (HSG) or suspected unilateral pathology on HSG. STUDY DESIGN: Charts of infertile women that underwent complete infertility evaluation between 1996 and 1998 were retrospectively reviewed. Eighty-six patients in whom both HSG and laparoscopy were performed were included in the study. HSG results were compared with laparoscopic findings and the suggested treatment based on HSG results was compared with the treatment plan based on laparoscopic findings. RESULTS: Among 63 patients with a normal HSG or suspected unilateral tubal pathology, who were assigned to ovulation induction and intrauterine insemination (IUI), 60 patients were found to have laparoscopic findings that did not necessitate any change in the original treatment plan. In three patients (4.8%), abnormalities discovered at laparoscopy were of such an extent that a change in the original treatment regimen and referral to in vitro fertilization (IVF) was needed. Among 23 patients with suspected bilateral tubal occlusion on HSG, 16 patients (69.6%) were found to have an abnormal laparoscopy with bilateral tubal adhesions, 6 patients (26%) had unilateral tubal adhesions, and 1 patient (4.3%) had pelvic adhesions with no obstruction. These latter findings led to changes in the original treatment plan of these seven patients from IVF to ovulation induction and IUI. CONCLUSIONS: Laparoscopy may be omitted in women with normal HSG or suspected unilateral distal tubal pathology on HSG, since it was not shown to change the original treatment plan indicated by HSG in 95% of the patients. However, laparoscopy should be recommended in cases with suspected bilateral tubal occlusion on HSG, since it altered the original treatment plan in 30% of the patients from IVF to induction of ovulation with IUI. The reassuring results found in the present study may be related to the low prevalence of pelvic inflammatory diseases and endometriosis in our population.     

The most suitable tests for studying chlamydial infection in women with sterility

The study was carried out on 280 infertile women (185 with primary and 95 with secondary infertility), patients of the University Clinic of Gynecologic Endocrinology and Infertility, Sofia. The present study was designed to estimate which is the most suitable test for detection of chlamydial infection in women with infertility. Evidence of past chlamydial infection was determined by the presence of antichlamydial IgG antibodies by commercial ELISA test. From 196 of the patients examined, 101 were positive for antichlamydial IgG antibodies (62.7%). 84 women were examined by means of direct antigen test for Chlamydia trachomatis from the endocervix (DIF. ELISA). Tubal patient was examined by means of hysterosalpingography and/or laparoscopy. In 34 women with unilateral or bilateral tubal occlusion the endocervical direct antigen test was positive in 4 (11.8%) and in 30 women with patient tubes 2 were positive by this test (6.7) In 38 women with tubal occlusion 29 of the women with unilateral or bilateral tubal occlusion had a presence of IgG antichlamydial antibodies in their sera (76.3%) compared to 17 of 38 women with patient tubes (44.7%). The results of the present study indicate that the examination antichlamydial IgG antibodies in the sera of women with infertility has a better predictive value with regard to tubal pathology compared to the direct antigen test for detection Chlamydia trachomatis in the endocervix. Examination for latent infection or reinfection has to be carried out before the administration of more invasive methods for the management of infertility.     

影响输卵管积水患者腹腔镜术后妊娠率的相关因素分析

目的:研究输卵管积水患者腹腔镜术后影响其自然妊娠率的高危因素,为患者个体化治疗提供临床依据。方法:回顾性分析我院2010年1月至2013年12月因输卵管积水行腹腔镜手术患者643例的临床资料,并对影响其自然妊娠率的因素进行单因素及多因素Logistic回归分析。结果:643例患者临床妊娠率为34.06%(219/643),正常宫内妊娠率为21.15%(136/643),流产率为3.89%(25/643),异位妊娠率为9.02%(58/643)。单因素分析结果显示,输卵管积水患者腹腔镜术后自然妊娠率与年龄、不孕年限、是否有盆腹腔手术史及盆腔输卵管病变程度有关(P0.1),与不孕类型、体质量指数、是否有异位妊娠史、单侧或双侧积水、主刀医师不同无关(P0.1);多因素分析显示,不孕年限5年(OR=1.539,P=0.008)和盆腔输卵管中、重度病变(OR=1.569,P=0.001)是输卵管积水患者腹腔镜术后影响其妊娠能力的独立危险因素。结论:在指导输卵管积水患者腹腔镜术后适时妊娠方面,应充分考虑患者的不孕年限和输卵管病变程度,实现个体化治疗,有望提高妊娠率。     

Influence of pelvic endometriosis and ovarian endometrioma on fertility

We investigated the influence of pelvic endometriosis and ovarian endometrioma on pregnancy outcome in women associated with infertility. A total of 237 women with endometriosis were reviewed, and their fertility rate was assessed by both r-AFS staging and TOP classification as previously proposed by our group. There was no significant difference in pregnancy rate among r-AFS stages. However, the pregnancy rate was mostly affected by the tubal condition according to the TOP classification as follows: no adhesive lesion (T0), 53% (69/129); unilateral lesion (T1), 46% (18/39); bilateral lesion with at least one tube patent, (T2), 37% (10/27); bilateral tubal occlusion (T3), 0% (0/8) (p < 0.05, Mantel-Extension test). The absence (O0-O1) or co-existence (O2-O3) of ovarian endometrioma and different gradings of cul-de-sac obliteration (P2-P3) showed no significant differences in pregnancy rate. The resulting conception rate was also not affected by the size or location of ovarian endometrioma. In addition, the higher adhesion score of ovarian endometrioma involving the fallopian tube and as described in r-AFS classification had a significant detrimental effect on fertility. These observations suggest that our TOP classification describing individual tubal condition has a clinically predictive value in assessing the reproductive outcome of women with endometriosis.     

Economic Evaluation of in vitro Fertilization-Embryo Transfer (IVF-ET) and Neosalpingostomy for Bilateral Tubal Obstruction

Objectives: to determine the reproductive outcome and estimate the cost for a Jive birth after a single IVF-ET cycle and neosalpingostomy via laparotomy or laparoscopy in patients with bilateral tubal obstruction.Design: retrospective review of medical records.Setting: tertiary reproductive medicine university institute.Patients: three cohorts of infertility patients, treated for bilateral tubal obstruction were compared. Thirty-seven patients with bilateral distal tubal obstruction were treated between July 1990 and July 1994 with laparoscopic bilateral neosalpingostomy using a Coherent ultra-pulse CO₂ laser. Seventy-two patients with bilateral distal tubal obstruction had undergone neosalpingostomy prior to July 1990 by laparotomy, using the CO₂ laser and microsurgical techniques. One hundred and twenty-seven patients with all forms of bilateral tubal obstruction were treated with a single cycle of IVF-ET in the same institute between July 1990 and December 1994. The three groups were comparable in female age and length of infertility.Results: the live birth rate was 19 percent (14 of 72), 22 percent (8 of 37) and 19 percent (24 of 127), and the ectopic pregnancy rate was seven percent (5 of 72), eight percent (3 of 37) and three percent (4 of 127) for the laparotomy, laparoscopy and IVF-ET cycle groups, respectively. The estimated cost for alive birth was $10,497 following laparoscopy, while it was $29,532 and $28,300 following laparotomy and IVF-ET, respectively.Conclusions: the reproductive performance following bilateral laparoscopic neosalpingostomy is at least equal to the pregnancy rate following neosalpingostomy via laparotomy and a single IVF-ET cycle. The least expensive live birth is associated with laparoscopic neosalpingostomy.     

Does hydrosalpinx reduce the pregnancy rate after in vitro fertilization?

Objective: To determine the effect of hydrosalpinges on the pregnancy rate in an IVF program.

Design: Multicentric retrospective analysis of clinical and laboratory data.

Setting: Two assisted reproductive technology centers in university hospitals.

Patient(s): Four hundred forty-three women, under 38 years of age, with pure tubal infertility. The patients were classified into the following five groups: bilateral hydrosalpinges (n = 37), unilateral hydrosalpinx (n = 54), bilateral tubal occlusion (n = 207), unilateral tubal occlusion (n = 55), and severe tubal disease without complete occlusion (n = 90).

Main Outcome Measure(s): Pregnancy and implantation rates.

Result(s): The pregnancy and the implantation rates per transfer (12.3% and 5.4%) obtained by women with bilateral hydrosalpinges are significantly lower than the rates (means = 23.1% and 12%) for all other tubal infertility groups.

Conclusion(s): Bilateral hydrosalpinges have a deleterious effect on the outcome of IVF program.     

Prognostic significance of diagnostic laparoscopy for spontaneous fertility

OBJECTIVE: To determine the prognostic significance of laparoscopy results for fertility outcome. STUDY DESIGN: Consecutive patients undergoing hysterosalpingography and laparoscopy for subfertility in our department between May 1985 and November 1987 were identified from medical records. The impact of tubal occlusion, hydrosalpinx and adhesions as detected at laparoscopy was studied. Kaplan-Meier curves for the occurrence of spontaneous intrauterine pregnancy were constructed for patients without tubal pathology, with mild tubal pathology (unilateral pathology or adhesions) and with severe tubal pathology (bilateral pathology). Fecundity rate ratios (FRR) were calculated to express the association between findings at laparoscopy and the occurrence of spontaneous intrauterine pregnancy. RESULTS: Of the 200 cases that could be analyzed, 129 (65%) showed no tubal occlusion on laparoscopy, 40 (20%) had unilateral tubal occlusion, and 31 (15%) had bilateral tubal occlusion. Unilateral hydrosalpinx was present in 13 (7%) patients, whereas 19 (10%) patients had bilateral hydrosalpinx. Adjusted FRRs were 0.65 and 0.20 for unilateral and bilateral tubal occlusion, and 0.46 and 0.32 for unilateral and bilateral hydrosalpinx. Peritubal adhesions were detected in 43% of patients and seemed to have no prognostic significance. CONCLUSION: Severe tubal pathology detected at laparoscopy affects fertility prospects strongly. However, since spontaneous intrauterine pregnancies occurred even in patients with bilateral tubal occlusion at laparoscopy, this technique should not be considered the gold standard in the diagnosis of tubal infertility.     

Adhesion reformation after reproductive surgery by videolaseroscopy

After initial videolaseroscopy for the treatment of endometriosis-associated infertility, 157 patients underwent a second-look laparoscopy to evaluate and treat recurrence of disease and/or adhesions. The patients were divided into two groups. Group 1 consisted of 135 patients who underwent second-look laparoscopy for persistent infertility and/or recurrence of pain. Group 2 consisted of 22 patients who achieved pregnancy after initial surgery and underwent second-look laparoscopy for evaluation of ectopic pregnancy or in association with uterine evacuation for first trimester spontaneous abortion. Both groups of patients demonstrated a significant reduction in adhesion scores involving the ovaries, tubes, posterior cul-de-sac, anterior cul-de-sac, and omentum/bowel. Although the initial mean adhesion scores were similar for both groups, at second-look laparoscopy the mean adhesion scores were significantly lower for group 2, particularly for ovarian and tubal adhesions. None of the patients formed de novo adhesions. From these results we may conclude that videolaseroscopy: (1) is effective in reducing peritoneal adhesions; (2) is associated with a low frequency of postoperative adhesion recurrence; and (3) appears to completely avoid de novo adhesion formation.