Am Fam Physician. 1998;57(4):856-858
Laparoscopy is being used with increasing frequency in the surgical management of benign ovarian masses. Despite the widespread use of laparoscopy for excision of ovarian masses and reported reductions in operative morbidity, hospital stay and recovery time, only a few studies have compared this technique with conventional laparotomy. Yuen and associates compared outcomes in patients who were randomly assigned to laparoscopy or laparotomy for the management of benign ovarian masses.
A total of 102 patients with tumors identified as benign by ultrasonography were included in the study. The mean surgery time did not differ between the two groups. Blood loss was significantly lower in the laparoscopy group, but no difference was apparent between the two groups in the postoperative change in hemoglobin level. The mean diameter of the tumors was 5.6 cm in the laparoscopy group and 5.7 cm in the laparotomy group.
All laparoscopic procedures were successfully completed. Surgical morbidity was significantly lower in the laparoscopy group than in the laparotomy group. This difference was mainly the result of the lower incidence of postoperative fever and urinary retention in the patients undergoing laparoscopy. The level of postoperative pain was significantly higher in the laparotomy group in the immediate postoperative period and within the first 24 hours after surgery. Analgesia was not required postoperatively in 54 percent of the patients in the laparoscopy group, compared with 10 percent of the laparotomy group.
The mean hospital stay was significantly shorter in the laparoscopy group (2.6 days versus 4.9 days), and patients who underwent laparoscopy were able to return to work sooner (17.9 days versus 30.4 days). They resumed oral intake sooner and were able to ambulate earlier in the course of recovery. More patients in the laparoscopy group were able to resume sexual activity within the first two weeks after operation. Patients in the laparoscopy group were more satisfied with the appearance of their surgical scar.
The authors note that the reported benefits of laparoscopic surgery generally are reported in studies conducted by very experienced surgeons. Although the laparoscopic approach is less invasive than laparotomy, the decision to perform one procedure or the other should be based on the same clinical criteria. The laparoscopic approach to the surgical management of benign ovarian masses offers a reduced hospital stay and recovery time. In the authors' opinion, it should replace laparotomy in the management of benign ovarian masses.