A Comparative Study of Pelviscopic Surgery Versus Laparotomy in Adnexal Diseases

Kim, K S; Oh, B C; Rhyu, C H; Kim, J D

Abstract

OBJECTIVE
To increase proportion of pelviscopic surgery, and besides, avoid unnecessary laparotomy for benignity and pelviscopic surgery of malignancy in adnexal masses.
METHODS
Adnexal masses were managed by laparotomy or laparoscopy under the stated guideline. We analyzed data of the surgical procedure, operative time, hospital stay, and complication, guideline applied and the operator`s opinion on the adequacy of each laparotomy.
RESULTS
Over an 18-month period, laparotomy [n=159] or pelviscopy [n=129] were performed. Mean operative time and hospital stay in the pelviscopy group were shorter than those in the laparotomy group. The proportion of laparotomy/pelviscopy were 55.2%/44.8% in overall, 44.5%/55.5% in non-neoplastic tumors, 58.1%/41.9% in benign neoplasm, 100.0%/0.0% in borderline tumor and 91.7%/8.3% in malignancy. The main reasons of laparotomies were unstable vital sign with some symptoms and signs of generalized peritonitis or hemoperitoneum[32.1%] and suspected severe pelvic or abdominal adhesion [24.5%] in non-neoplastic tumor. The patients of benign neoplasms had laparotomies chiefly due to elaborate enucleation in the cyst of diameter 6cm for fertility[26.7%] and suspected severe pelvic or abdominal adhesion [18.6%]. Pelviscopic surgery of ovarian cancer was 1 case [0.78%]. Operator was of opinion that the rate of inadequacy in laparotomies was 28.9% in overall.
CONCLUSION
Pelviscopic surgery is superior to laparotomy in the management of adnexal masses and may be considered prudently in patients of pelvic adhesion suspected and in adnexal tumors those can`t confirm as benignancy. In addition to preoperative evaluations, operative findigs and frozen biopsy should be obtained more carefully for pelviscopy of adnexal tumors.