As a young physician, I was taught that when a patient presents with a ruptured ectopic pregnancy and was hemodynamically unstable, the correct course was to perform a laparotomy for immediate control of the bleeding. At that time (around the year 2000), complex laparoscopy was not really in wide practice, a
nd a physician who suggested that they could control bleeding laparoscopically as quickly as they could via laparotomy would have been met with skepticism. In some cases, a physician suggesting a laparoscopic approach to the problem might be blocked by the atten
ding anesthesiologist, who often holds veto power over certain surgical decisions. The idea was that the bleeding needs to be stopped quickly, and the way to do that is a laparotomy.
But over time, our ability to do things quickly and effectively via laparoscopy has changed, and I think our understanding of hemodynamic instability in young women has changed as well.