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reported a three times higher conversion rate, when fibroids measured more than 8 cm, or located anteriorly. Conversion to a laparotomy is actually a prudent judgment on the part of the surgeon. The similar accurate multilayered repair of the uterine wound can be performed by robotic laparoscopic surgery,10 about which we do not have any experience. The incision line may be covered by adhesion-preventing barriers to prevent postoperative adhesions11 with debatable benefit.12 We use omental patch for cost-saving. Laparoscopic myomectomy is a preferred procedure for fibroids less than 5 cm diameter, though larger fibroids are excised in similar way. Though multilayered suture is preferred,13 successful single-layered laparoscopic suturing following removal of large fibroids have already been presented in literature.14 Out of 136 cases of uterine fibroid, 45 cases of laparoscopic myomectomy were performed. Among the rest 91 cases, 80 cases needed suturing of uterine cavity by small laparotomy wound, for proper repair in layers. 11 cases were converted to total abdominal myomectomy. In small fibroid, less than 4 cm, single-layered suturing was sufficient. Laparoscopic management of ovarian cysts has been controversial.15 It has gone through tremendous scrutiny and evaluation with the trend now moving toward increasing acceptance.16,17 Ovarian cysts were simple serous cysts, dermoid cysts, chocolate cysts, rarely mucinous cystadenoma and very rarely hemorrhagic corpus luteal or serosal cysts. The commonest ovarian cysts in infertile women were chocolate cysts, the management of which is mentioned previously. Care should be taken to avoid spillage of cyst material of dermoid Siddhartha Chatterjee et al 14 JAYPEE cyst in the abdominal cavity during cyst removal to prevent severe adhesion formation. For large dermoid cysts, laparoscopy-assisted open ovarian cystectomy may be performed,17 either abdominally or through colpotomy wound. Posterior colpotomy was not associated with significant postoperative adhesion.18 Small or average sized cysts, after removal, may be brought out in a specially prepared plastic bag, otherwise called a lapsac or endobag. Large ovarian cyst may displace the fallopian tube and, thereby, can impair oocyte pick-up. They may be silent at times. Ovarian cystectomy is always the operation of choice, because the removed cyst wall can be subjected to histopathological examination, and subsequent recurrence is lessened.8 Other procedures may be drainage or thermoablation. Large hydrosalpinx needs surgical management, even before IVF procedure is undertaken. Neosalpingostomy yields little success. Excision of hydrosalpinx, drainage, clipping of cornual end or discontinuation of cornual end of fallopian tube may be procedures of choice before IVF. There is controversy about the management of hydrosalpinx, but it is agreed that hydrosalpingeal fluid has antifertility effect even in IVF at different levels, like COH, folliculogenesis as well as implantation. Availability of free POD is a prerequisite for non-ART pregnancy. POD acts as a reservoir for egg, and so also a place for tubal fimbrial play. Adhesion in POD, either infective or endometriotic, hinders the above functions, either by seduction of eggs on, by affecting oocyte pick-up. Infective adhesions can be separated by diathermy hook or forceps, if they are vascular. Scissors dissection is performed when they are avascular. Endometriotic pseudomembranes are better excised, as they reform quickly. Sometimes through and through, adhesion in the lower part of POD, particularly in deep pelvis, may be left alone, as the upper part can provide the function of POD successfully and does not impair fertility. Laparoscopic ovarian drilling (LOD) is a widely discussed procedure and has not been included in this study. The pregnancy outcome following surgical corrections was compared to IVF procedural outcome in three different groups: (1) Minor tubal defects, ovarian cyst and uterine fibroids (2) major tubal defects, and (3) severe endometriosis. OBSERVATION A total of 3,982 cases of laparoscopic surgeries performed in infertile women were presented with different pathologies. These pathologies along with the incidences are presented in Table 1. It was observed that minor tubal defects in this series were premier indication for FPLS (49.6%); ovarian pathologies and endometriosis were distant followers (19.2 and 14.5% respectively). Among tubal pathologies, minor tubal defects were major component (1,405 cases). Incidence of different types of minor tubal defects is presented in Table 2. TOR is another important factor for the promotion of non-ART pregnancy, and the results after correction are mentioned in Table 3. Maximum number of cases was in TOR 2 and TOR 3 positions. The aim of surgical correction was to bring the relation to TOR 4 position, if possible. After correction, TOR 1 position could be taken maximally to TOR 2 and TOR 3 positions; from TOR 2 to TOR 3 with not much of difficulty; and from TOR 3, easily to TOR 4 position. RESULTS During the last 14 years, 3,982 cases of operative laparoscopic procedures were performed. The pregnancy outcomes are mentioned in Tables 1 and 2. It is observed that the pregnancy rate after laparoscopic surgery remained between 25 and
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