The most difficult surgical skill required for laparoscopy was effective suturing. Many devices were created to replace traditional suturing, in the early stages of laparoscopy. Surgical modifications, such as stapling, were devised to avoid suturing. The development of the extracorporeal knot made almost any laparotomy procedure feasible by laparoscopy. Once suturing was mastered, classical operations were duplicated through the laparoscope.
Surgical success starts with a good pre-operative evaluation and diagnosis.
Laparoscopic surgeons have been keenly aware that many gynecologists consider laparoscopy inferior to vaginal or abdominal surgery. Five-year data is now available on many laparoscopic procedures. The initial study had 81 subjects, and more than one third of these patients had prior bladder surgery. Since both of these procedures are done exactly the same way as open procedures, it is not surprising the outcomes are similar. Earlier laparoscopic studies that reported poorer results for urinary incontinence had major modifications from the classic Burch, leading to poor outcomes, in this author s opinion.