Treating adnexal masses. Operative laparoscopy vs. laparotomy

OBJECTIVE: To compare operative laparoscopy vs. laparotomy for the treatment of adnexal masses. STUDY DESIGN: A retrospective review of all surgical cases who underwent operative laparoscopy or laparotomy for an adnexal mass during 1988-1995 at one multispecialty group practice. Preoperative screening for women over 45 included a CA-125 and ultrasound. If a malignant mass was encountered, it was immediately staged by laparotomy with the assistance of a surgical oncologist. During the study period 121 patients underwent ovarian cystectomy and 284 patients, oophorectomy. RESULTS: Laparoscopy was successfully completed in 118 of 127 (93%) oophorectomy and 71 of 72 (98%) of ovarian cystectomy patients. The incidence of malignant lesions at operative laparoscopy was 2%. The hospital stay for ovarian cystectomy was significantly shorter for laparoscopy (0.8 vs. 3.1 days). Hospital stay for oophorectomy was significantly shorter for laparoscopy (0.8 vs. 4.1 days). Ovarian cystectomy by laparotomy resulted in slightly more total complications than did laparoscopy (8% vs. 1%). Oophorectomy by laparotomy resulted in significantly more total complications than did oophorectomy by laparoscopy (29% vs. 3%). The mean total charge for laparoscopic oophorectomy was $5,873 versus $7,007 for laparotomy. The mean total charge for laparoscopic ovarian cystectomy was $4,507 vs. $5,541 for laparotomy. CONCLUSION: Treatment of adnexal masses by operative laparoscopy can be performed safely, with reduced morbidity and patient disability, and at a reduced cost. By having an oncologist backup in house, we have been able to convert most procedures to the laparoscopic approach.