Laparoscopic microsurgery: current and future status.

The successful introduction of microsuturing and microinstruments for operative laparoscopy has allowed the convergence of laparoscopy and traditional microsurgery, resulting in the evolution of the 'new microsurgery'. This more dynamic approach overcomes the limitations of open microsurgery by providing continuous magnification and the benefits of a closed environment, making laparoscopy a complete surgical tool. The test model for microsurgery is tubal anastomosis, which is very dependent on operative technique to attain well-established pregnancy rates. Our cumulative pregnancy results for laparoscopic microsurgical tubal anastomosis of 76% at 12 months, 70% at 9 months, 67% at 6 months and 44% at 3 months, compares favorably to the best results achieved by traditional open microsurgery. With this validation the technique is now employed as a complete solution for all tubal surgery. The ability to effect microsurgical repair of the ureter, bladder, bowel and vessels has expanded the surgical repertoire, allowing radical excision of deep endometriosis, severe enterolysis, and adhesiolysis.

Laparoscopic microsurgical tubal anastomosis.

The authors explored the feasibility of performing true microsurgery through the laparoscope in 1990. The first laparoscopic microsurgical tubal anastomosis was performed in February 1992. Operative laparoscopy will continue to expand as technical feasibility continues to improve, driven by both hardware advances and increased surgical dexterity. Laparoscopic microsurgery will introduce a new dimension to reproductive surgery and over time, will replace laparotomy for microsurgery.

Acidic furo[3,2-b]indoles. A new series of potent antiallergy agents.

A series of furo[3,2-b]indole carboxylic acids, tetrazoles, and carbamoyltetrazoles was prepared and tested in vitro with use of a model of active pulmonary anaphylaxis, the modified Schultz-Dale Test (SDT). In this model, isolated guinea pig lung strips are repeatedly challenged with antigen in the presence of an antihistamine (H1). Most of the acidic furo[3,2-b]indoles tested inhibited the leukotriene-mediated lung contraction in a dose-related manner. Compounds with an N-phenyl substituent were more potent (IC50 less than or equal to 5.0 microM) inhibitors of SDT than the N-methyl analogues (IC50 greater than or equal to 22.0 microM). Most of the N-phenyl analogues were more potent in SDT than Fisons' mediator-release inhibitor proxicromil (FPL-57,787; IC50 = 6.3 microM). The most potent furo[3,2-b]indoles were those unsubstituted at C-7 and with N-phenyl, 2-carbamoyltetrazole, and 3-alkoxy substituents. All of the carboxylic acid ester analogues tested were weak or inactive at concentrations of 10-30 microM.