| A Comparative Study of Pelviscopic Surgery Versus Laparotomy in Adnexal Diseases. |
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K S Kim, B C Oh, C H Rhyu, J D Kim |
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| 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. |
| Key Words:
Laparoscopy, Pelviscopy, Laparotomy, Adnexal mass |
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