Trends in Oophorectomy by Laparoscopic versus Open Techniques

We studied all patients who underwent oophorectomy either by laparoscopy or laparotomy performed by one of our physicians from 1988 to 1995. Preoperative screening for women over 40 included a CA 125 and ultrasound examination. Malignant masses were immediately staged by laparotomy with the assistance of our surgical oncologist (R.O.). We compared 128 women in whom laparoscopic management was attempted with 157 who had a primary laparotomy. Our first laparoscopic oophorectomy was performed in 1989, and during 1995, 37 (73%) of 51 patients underwent the procedure. The failure rate for laparoscopy was 3.3% during the study period. The operating time was the same for both groups. With laparoscopy the mean size of the mass was 5.5 cm (range 3-16 cm). Complication rates were higher for laparotomy than for laparoscopy (29% vs 4%). In the laparoscopy group, two tumors of low malignant potential and one ovarian cancer were found (2.3%). With the increasing application of laparoscopy we reduced yearly average length of hospital stay for oophorectomy from 4.3 to 1.4 days. A cost analysis was completed comparing the two groups. Laparoscopic oophorectomy can be performed safely, with reduced morbidity and patient disability. By having a oncologist backup we have been able to convert most procedures to the laparoscopic approach.