Laparoscopic minilaparotomy: a suitable addition to major gynaecological surgery?

The study aimed to determine whether laparoscopic minilaparotomy can combine the advantages of both laparoscopic and laparotomy surgical techniques. Laparoscopic minilaparotomy was performed when it was considered that binocular vision, finger dissection or palpation, or laparotomy instruments would offer a distinct advantage over laparoscopy techniques to make surgery easier, quicker, safer or cheaper. A total of 18 patients were operated on at Cliveden Hospital during 1994 and 1995, by two gynaecologists skilled in advanced operative laparoscopic techniques. The patients required excision of a large ovarian endometrioma (3), rectovaginal endometriosis (3), an adherent tubo-ovarian mass (2), a myoma > 6 cm (5), hysterectomy (4) and bowel repair (1). The results were subjective as a controlled study was not performed. Both surgeons considered the use of minilaparotomy surgery easier and quicker, particularly for removal of large endometriomas, extensive rectovaginal endometriosis and an adherent tubo-ovarian mass. There were no complications resulting from the use of the technique. It is concluded that the combination of the advantages of laparoscopy and laparotomy is feasible by using minilaparotomy. Further study of laparoscopic minilaparotomy is recommended. Minilaparotomy may expand the use of laparoscopic techniques which are found to be more difficult or slower than laparotomy, and encourage surgeons to develop new equipment and techniques for operations previously considered unsuitable for laparoscopic surgery.