Laparoscopy versus laparotomy for benign ovarian tumours (Review)

Abstract

Background: Over the last ten years laparoscopy and minilaparotomy have become increasingly common approaches for the surgical removal of benign ovarian tumours. However in the event that a tumour is found to be malignant, laparotomy is the appropriate procedure. Careful preoperative assessment including transvaginal ultrasound with morphological scoring, colour doppler assessment of vascular quality and a serum Ca125 level is desirable. Objectives: To determine the benefits, harms and cost of laparoscopy or minilaparotomy compared with laparotomy in women with benign ovarian tumours. Search strategy: We searched electronic databases, trials registers and reference lists of published trial reports. Reference lists from trials and review articles were also searched. Selection criteria: All randomised controlled trials comparing either laparoscopy or minilaparotomy with laparotomy for benign ovarian tumours. Data collection and analysis: Eight reviewers independently assessed the eligibility and quality of each study, and independently extracted the data Main results The results of nine randomised controlled trials (n=482 women) showed that laparoscopic surgery was associated with fewer adverse events of surgery (surgical injury or post operative complications including fever or infection) (OR 0.3 95% CI 0.2 to 0.5), less post operative pain (VAS scores WMD -2.4 95% CI -2.7 to -2.0), greater likelihood of being pain free after 2 days (OR 7.42 95% CI 4.86 to 11.33) and fewer days in hospital (WMD -2.88 95%CI -3.1 to -2.7) . In one study that reported costs, laparoscopy was associated with a significant reduction compared to laparotomy(WMD - $1045 95%CI -$1348 to -$742) in US $ in 1993. Very high levels of heterogeneity made it inappropriate to pool data on duration of surgery. Three RCT’s compared laparoscopy versus minilaparotomy and found that laparoscopy was associated with reduced odds of any adverse event (surgical injury or postoperative complications ) (OR 0.10 95% CI 0 to 0.8) lower VAS scores for pain (WMD -1.0 95%CI -1.6 to -0.45). Duration of hospital stay ranged between 1 and 2.2 days with substantial heterogeneity. Authors’ conclusions In women undergoing surgery for benign ovarian tumours, laparoscopy was associated with a reduction in fever, urinary tract infection, post operative complications, post operative pain, number of days in the hospital and total cost. These findings should be interpreted with caution since only a small number of studies were identified including a total of only 769 women and not all of the important outcomes were reported in each study.