Frontiers of operative laparoscopy: a review and critique of the evidence.

OBJECTIVE: This report reviews the evidence supporting the use of operative laparoscopy for a number of expanded indications in gynecology. STUDY DESIGN: Studies published in English were identified through a Medline search back to 1966 for literature listed under the medical subject heading of "peritoneoscopy"; this search was supplemented by reviews of reference lists and discussions with experts. RESULTS: Fair evidence exists to recommend use of laparoscopy for ectopic pregnancy, ovarian biopsy, and treatment of polycystic ovarian syndrome resistant to clomiphene citrate therapy. Evidence concerning other indications is inadequate to allow recommendations. CONCLUSIONS: Mechanisms are urgently needed to evaluate surgical innovations in gynecology with the same degree of scientific rigor currently afforded medical innovations. Without surgical technology assessment, the current double standards in gynecologic therapy will persist.