Laparoscopy compared with laparoscopically guided minilaparotomy for large adnexal masses: a randomized controlled trial. Randomized comparative study of culdoscopy and minilaparotomy for surgical contraception in women. Comparison of three types of tubal sterilisation: the medan experience. Minilaparotomy versus laparoscopy in the treatment of benign adnexal cysts: a randomized clinical study. Laparoscopy or minilaparotomy for sterilization of women. Laparoscopic-assisted vaginal hysterectomy versus minilaparotomy hysterectomy: a prospective, randomized, multicenter study. Safety of laparoscopy versus laparotomy in early-stage endometrial cancer: a randomised trial. A randomized controlled comparison of minialpartomy and lapartomy in ectopic pregnancy cases. A randomized prospective study of laparoscopy and laparotomy in the management of benign ovarian masses.
To address the efficacy in terms of intraperitoneal spillage of laparoscopically guided minilaparotomy compared with operative laparoscopy for large adnexal cysts.
                A randomized controlled trial was carried out at a tertiary referral center from January 2005 to September 2006. Sixty eligible patients affected by nonendometriotic adnexal cysts with diameter between 7 and 18 cm were randomly assigned to either operative laparoscopy or laparoscopically guided minilaparotomy.
                The relative risk for intraperitoneal spillage among women treated with laparoscopy was 5.55 (95% confidence interval 1.88-16.33). Operative times were significantly shorter in patients who underwent laparoscopically guided minilaparotomy. Surgical difficulty was significantly higher in patients treated with laparoscopy. However, postoperative stay was shorter.
                Laparoscopically guided minilaparotomy, when compared with laparoscopy, is able to reduce intraperitoneal spillage in patients with presumably benign large adnexal masses, with minimal increase in patient short- and long-term discomfort. Because data regarding the importance of intraperitoneal spillage during surgery for benign and malignant pathologies, as well as rupture rates during traditional laparotomy, are scarce, traditional laparotomy still represents the standard treatment. In women desiring a minimally invasive strategy for large cysts, laparoscopically guided minilaparotomy should be considered.
                Australian Clinical Trials Registry, www.actr.org.au, ACTR N012607000241437,
                I. Informed, healthy, volunteering women seeking interval sterilization were randomly allocated either to culdoscopy or to minilaparotomy. Data concerning the operation and follow-up to six weeks post-operation were analyzed for 199 women in the culdoscopy group and 196 in the minilaparotomy group. Major complications, both at operation and subsequently, occurred only in the vaginal procedure group (3%). Minor complications occurred in 3.6% of women in the minilaparotomy group, the majority of these involving the abdominal wound. In the women operated vaginally, minor complications occurred in 1.5%. Failure to perform the intended procedure on the fallopian tubes occurred in 10.6% of culdoscopy cases and 0.5% of minilaparotomy cases. It is concluded that the vaginal approach cannot be recommended except for surgeons experienced in vaginal surgery. Three methods of tubal sterilisation, viz. laparoscopy, culdoscopy and minilaparotomy, were evaluated in a trial involving 300 voluntary acceptors at the University Hospital in Medan, Indonesia. Equal numbers of women were randomly assigned to the three surgical groups. The results showed little differences among patients in the three groups for age, number of living children, contraceptive and abortion histories and pre-existing medical conditions. As expected, average surgical time for minilaparotomy was significantly higher than the times reported for the endoscopic techniques. Minilaparotomy also produced the highest incidence of operative complications while culdoscopy accounted for the highest rate of hospitalisation following operation. Four-year follow-up of the patients revealed only one case of pregnancy in the culdoscopy group, three years after tubectomy . To determine advantages and disadvantages of minilaparotomy and laparoscopy in managing patients affected by benign adnexal masses.
                Prospective, randomized, clinical trial on 127 patients affected by adnexal cysts. Patients were submitted to adnexal surgery through a laparoscopic or minilaparotomy approach on a random basis.
                Hundred and twenty-seven patients were enrolled in the study and randomly assigned to laparoscopy (63 patients) or minilaparotomy (64 patients). Characteristics of the patients and of the cysts were homogeneous between the two groups. No significant differences between the two groups were recorded in terms of operative time, intraoperative complications, ileus, length of stay and recovery time. The intraoperative rupture rate of the cyst was significantly higher in the laparoscopy group only in a subgroup of patients affected by cysts greater than 7 cm in diameter (p=0.01). Three patients randomized to laparoscopy required conversion to laparotomy. Concerning postoperative outcomes, postoperative pain and minor complications were significantly less in patients undergoing laparoscopy (p=0.001 and 0.04).
                Operative laparoscopy appears to be the preferable approach for the management of adnexal cysts. Minilaparotomy can be considered a mini-invasive approach as well, with acceptable operative and postoperative outcomes, and is a suitable alternative in case of contraindications to laparoscopy. A prospective randomly controlled study was conducted on 200 women undergoing sterilization by application of clips to the fallopian tubes. Laparotomy or laparoscopy was used, and the patients' response to the procedure was evaluated. There were few surgical complications. Postoperative pain and discomfort were experienced for a mean of 2.7 and 2.4 days in the those undergoing minilaparotomy and laparoscopy, respectively. The patients' response indicates a marginal benefit from the laparoscopic approach to application of clips to the fallopian tubes. The aim of this study was to compare operative and early postoperative outcomes of laparoscopic-assisted vaginal hysterectomy (LAVH) and minilaparotomy in a randomized clinical trial including patients undergoing total hysterectomy for benign gynecologic disease and having 1 or more of the generally considered contraindications to vaginal route.
                Prospective, randomized, multicenter trial (Canadian Task Force classification I).
                Departments of Gynecology from 3 major university hospitals in Rome.
                Eighty-one patients who were candidates for abdominal hysterectomy.
                Laparoscopic-assisted vaginal hysterectomy and minilaparotomy hysterectomy.
                Forty patients were randomized to LAVH and 41 to minilaparotomy. Characteristics of patients and indications for surgery in the 2 arms were comparable. In the minilaparotomy group, complications were as follows: 1 case (2.4%) of delayed laparotomy with 2 units of red blood cell transfusion, 2 cases (4.8%) of wound infection, and 3 cases (7.3%) of fever of unknown origin. No minor or major complications were observed in the LAVH group. Postoperative visual analog scale pain scores at days 1 and 2 were significantly lower in the LAVH group (p <.05). The complication rate between the 2 groups was significantly lower for LAVH (p = .026).
                Because LAVH was associated with significantly lower early postoperative pain scores and complication rates, in general LAVH should be preferred to minilaparotomy hysterectomy when the vaginal approach cannot be used. The standard surgery for early-stage endometrial cancer is total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy, which is associated with substantial morbidity. Total laparoscopic hysterectomy (TLH) and bilateral salpingo-oophorectomy is less invasive and is assumed to be associated with lower morbidity, particularly in obese women. This study investigated the complication rate of TLH versus TAH in women with early-stage endometrial cancer.
                This randomised trial was done in 21 hospitals in The Netherlands, and 26 gynaecologists with proven sufficient skills in TLH participated. 283 patients with stage I endometrioid adenocarcinoma or complex atypical hyperplasia were randomly allocated (2:1) to the intervention group (TLH, n=187) or control group (TAH, n=96). Randomisation by sequential number generation was done centrally in alternate blocks of six and three participants, with stratification by trial centre. After assignment, the study coordinators, patients, gynaecologists, and members of the panel were not masked to intervention. The primary outcome was major complication rate, assessed by an independent panel. Data were analysed by a modified intention-to-treat analysis, since two patients in both groups were excluded from the main analysis. This trial is registered with the Dutch trial registry, number NTR821.
                The proportion of major complications was 14.6% (27 of 185) in the TLH group versus 14.9% (14 of 94) in the TAH group, with a difference of -0.3% (95% CI -9.1 to 8.5; p=0.95). The proportion of patients with an intraoperative major complication (nine of 279 [3.2%]) was lower than the proportion with a postoperative major complication (32 of 279 [11.5%]) and did not differ between TLH (five of 185 [2.7%]) and TAH (four of 94 [4.3%]; p=0.49). The proportion of patients with a minor complication was 13.0% (24 of 185) in the TLH group and 11.7% (11 of 94) in the TAH group (p=0.76). Conversion to laparotomy occurred in 10.8% (20 of 185) of the laparoscopic procedures. TLH was associated with significantly less blood loss (p<0.0001), less use of pain medication (p<0.0001), a shorter hospital stay (p<0.0001), and a faster recovery (p=0.002), but the procedure took longer than TAH (p<0.0001).
                Our results showed no evidence of a benefit for TLH over TAH in terms of major complications, but TLH (done by skilled surgeons) was beneficial in terms of a shorter hospital stay, less pain, and quicker resumption of daily activities.
                The Dutch Organization for Health Research and Development (ZonMw), programme efficacy.
                2010 Elsevier Ltd. All rights reserved. As ectopic pregnancy is associated with significant maternal mortality and morbidity it may be worthwhile to find alternative surgical method to traditional laparotomy.
                To compare the efficacy, safety and cost effectiveness of minilaparotomy surgery for ectopic pregnancy cases with standard laparotomy method.
                A total of 60 patients of ectopic pregnancy were randomized for minilaparotomy and laparotomy (30 cases each) for three years from January. 1998 to March 2001 in a medical college hospital.
                Patients history, clinical examination, intraoperative, preoperative and postoperative data were recorded and compared in minilaparotomy and laparotomy groups.
                Chi-square and Fischer chi-square test is used using P value of less than 0.05 as level of significance.
                Mean operative time was significantly less in minilaparotomy (38 minutes) than in laparotomy group (54 minutes). Postoperative complications were fever in 4(13.33%) and 6(20%) cases, paralytic ileus in 3(10%) and 8(26.66%) cases, urinary tract infection in 2(6.66%) and 3(10%) cases and wound infection in 1(3.33%) and 5(16.66%) cases respectively in the two groups and were significantly less in the minilaparotomy cases. Mean day of mobility, starting normal diet and discharge from the hospital were 10 hours and 24 hours, 1.5 days and 3.1 days and 3.4 days and 6.9 days respectively in the two groups and were significantly less in the minilaparotomy group than the laparotomy group.
                Surgery by minilaparotomy technique in ectopic pregnancy cases appears to be a safe and feasible method and is superior to conventional laparotomy as there are minimum perioperative and postoperative complications and patients can be discharged early from the hospital without the need of expensive equipment. Our purpose was to compare the results of laparoscopy with laparotomy in the management of ovarian masses not suspected to be malignant.
                In a prospective randomized study 102 patients requiring surgical management of ovarian masses were randomly assigned to laparoscopy (52) or laparotomy (50) in a teaching hospital from July 1994 to September 1995. Inclusion criteria was tumor not suspected to be malignant with a diameter of < or = 10 cm as measured by ultrasonography. All operations were performed by trainees under the supervision of an experienced surgeon. Statistical analysis included t tests and chi2 tests.
                There were no differences in demographic characteristics between the two groups nor any difference in the size of ovarian masses, adnexal adhesion score, or frequency of bilateral disease. All the ovarian masses were benign. Endometriotic cysts and dermoid cysts were the most common disorder in the two groups. Cystectomy was performed in > 70% of cases in each group. Operating time was not increased with the laparoscopic approach, and the frequency of inadvertent rupture of the ovarian masses was just as high as in laparotomy. The laparoscopic approach was associated with a significant reduction in operative morbidity (odds ratio 0.34, 95% confidence interval 0.13 to 0.88), postoperative pain and analgesic requirement, hospital stay, and recovery period. Patients in general were satisfied with the operation, but significantly more patients were satisfied with the laparoscopy scar.
                Operative laparoscopy should replace laparotomy in the management of benign ovarian masses.
Major morbidity seems to be a rare outcome for both, laparoscopy and minilaparotomy. Personal preference of the woman and/or of the surgeon can guide the choice of technique. Practical aspects must be taken into account before implementing endoscopic techniques in settings with limited resources. Culdoscopy is not recommended as it carries a higher complication rate.