Second-Look Microlaparoscopy

Second-look laparoscopy performed a short time after corrective surgery to determine reproductive function has always been controversial. The need for general anesthesia and additional abdominal wall trauma make it unpopular. However, postponing pelvic evaluation after the original surgery results in a large proportion of women attempting pregnancy with deformed anatomy as the result of reformation of pelvic adhesions. Since November 1995 we performed microlaparoscopy for a second look in 20 patients. Original procedures were performed for endometriosis, salpingo-oophorolysis, tubal repair, and complicated ectopic pregnancy. Six of the women had adhesions that interfered with fertility and were referred to an assisted reproduction technology (ART) program. Procedures lasted 14 minutes (range 10-17 min). We encountered no complications. Patients were discharged after 2 hours of recovery and resumed normal activity. Second-look microlaparoscopy can be an important tool in assessing the efficacy of reconstructive reproductive surgery, and in accelerating referral to ART programs in women with poor results.