Mini-laparotomy versus laparoscopy for gynecologic conditions.

STUDY OBJECTIVE

To compare conversion rates, operative time, and estimated blood loss in patients undergoing mini-laparotomy (<4 cm vertical or transverse abdominal incision) versus laparoscopy for treatment of benign gynecologic conditions.

DESIGN

Retrospective study (Canadian Task Force classification II-2).

SETTING

Academic medical center.

PATIENTS

Women who underwent laparoscopy or mini-laparotomy for treatment of gynecologic conditions from January 2002 to March 2011. Patients who underwent hysterectomy as part of the surgery, cancer staging procedure, pregnancy-related procedure, or diagnostic surgery alone were excluded.

INTERVENTIONS

Mini-laparotomy or laparoscopy.

MEASUREMENT AND MAIN RESULTS

Primary outcomes were operative time and estimated blood loss. Secondary outcomes were hospital readmission, repeat operation, overnight hospital admission, emergency room visits because of surgery-related signs or symptoms, and wound complications. Of 950 medical records examined, 493 patients (52%) met the inclusion criteria, of which 141 (29%) underwent mini-laparotomy and 352 (71%) underwent laparoscopy. The groups had similar indications for surgery and level of surgical assistant. Patients who underwent mini-laparotomy were older than those who underwent laparoscopy. In patients who underwent mini-laparotomy, mean operative time was significantly shorter (49.3 versus 91.5 minutes; p = .003), and estimated blood loss was less (20 versus 32 mL; p = .001). The cumulative secondary outcome rate was not statistically different between the 2 groups (15% versus 16%). When each secondary outcome (conversion, repeat operation, overnight hospital admission, readmission to the hospitalization, emergency department visit, and wound complication) was examined independently, only the wound complication rate was significantly higher in the mini-laparotomy group compared with the laparoscopy group (5 of 141 patients versus 1 of 352 patients; p = .008).

CONCLUSIONS

Mini-laparotomy is a safe alternative to traditional minimally invasive approaches in gynecology and offers the additional benefits of shorter intraoperative time and less blood loss; however, it is associated with a significantly higher rate of major wound complications. Mini-laparotomy is an important surgical approach and should be included in gynecologic surgical training.