Laparoscopic adnexectomy: a comparison with laparotomy

Our purpose was to compare the newer technique of laparoscopic adnexal excision with conventional laparotomy.

With the same entry criteria, a retrospective, consecutive series of 26 women who underwent adnexectomy by laparotomy was compared with a later prospective consecutive series of 64 women who had laparoscopic adnexectomy in a university referral practice. The two groups were similar in all characteristics examined. The ages of the women ranged from 18 to 70 years, but only two women were postmenopausal. Pelvic pain with or without an ovarian cystic mass was the surgical indication in 91% to 92% of the women. Seven women had a persistent adnexal cystic mass and one woman had a unilateral androgen-secreting ovary. Bipolar coagulation was the laparoscopic method used.

Median operating time (88 vs 107 minutes), blood loss (72 vs 222 ml), days in the hospital (1 day vs 3 days), total costs ($4573 vs $6044), and recovery time (1 week vs 4 weeks) were significantly less with laparoscopic adnexectomy. There were no differences between the two techniques in major complications (one in each group), blood transfusions, adhesion formation, or the proportion of women noting improvement of pain symptoms.

In this preliminary assessment of laparoscopic adnexectomy, this surgical procedure offers significant advantages to laparotomy in selected patients when performed by a laparoscopist experienced in advanced techniques.