Laparoscopy compared with laparoscopically guided minilaparotomy for large adnexal masses: a randomized controlled trial. Randomized comparative study of culdoscopy and minilaparotomy for surgical contraception in women. Comparison of three types of tubal sterilisation: the medan experience. Minilaparotomy versus laparoscopy in the treatment of benign adnexal cysts: a randomized clinical study.
To address the efficacy in terms of intraperitoneal spillage of laparoscopically guided minilaparotomy compared with operative laparoscopy for large adnexal cysts.
                A randomized controlled trial was carried out at a tertiary referral center from January 2005 to September 2006. Sixty eligible patients affected by nonendometriotic adnexal cysts with diameter between 7 and 18 cm were randomly assigned to either operative laparoscopy or laparoscopically guided minilaparotomy.
                The relative risk for intraperitoneal spillage among women treated with laparoscopy was 5.55 (95% confidence interval 1.88-16.33). Operative times were significantly shorter in patients who underwent laparoscopically guided minilaparotomy. Surgical difficulty was significantly higher in patients treated with laparoscopy. However, postoperative stay was shorter.
                Laparoscopically guided minilaparotomy, when compared with laparoscopy, is able to reduce intraperitoneal spillage in patients with presumably benign large adnexal masses, with minimal increase in patient short- and long-term discomfort. Because data regarding the importance of intraperitoneal spillage during surgery for benign and malignant pathologies, as well as rupture rates during traditional laparotomy, are scarce, traditional laparotomy still represents the standard treatment. In women desiring a minimally invasive strategy for large cysts, laparoscopically guided minilaparotomy should be considered.
                Australian Clinical Trials Registry, www.actr.org.au, ACTR N012607000241437,
                I. Informed, healthy, volunteering women seeking interval sterilization were randomly allocated either to culdoscopy or to minilaparotomy. Data concerning the operation and follow-up to six weeks post-operation were analyzed for 199 women in the culdoscopy group and 196 in the minilaparotomy group. Major complications, both at operation and subsequently, occurred only in the vaginal procedure group (3%). Minor complications occurred in 3.6% of women in the minilaparotomy group, the majority of these involving the abdominal wound. In the women operated vaginally, minor complications occurred in 1.5%. Failure to perform the intended procedure on the fallopian tubes occurred in 10.6% of culdoscopy cases and 0.5% of minilaparotomy cases. It is concluded that the vaginal approach cannot be recommended except for surgeons experienced in vaginal surgery. Three methods of tubal sterilisation, viz. laparoscopy, culdoscopy and minilaparotomy, were evaluated in a trial involving 300 voluntary acceptors at the University Hospital in Medan, Indonesia. Equal numbers of women were randomly assigned to the three surgical groups. The results showed little differences among patients in the three groups for age, number of living children, contraceptive and abortion histories and pre-existing medical conditions. As expected, average surgical time for minilaparotomy was significantly higher than the times reported for the endoscopic techniques. Minilaparotomy also produced the highest incidence of operative complications while culdoscopy accounted for the highest rate of hospitalisation following operation. Four-year follow-up of the patients revealed only one case of pregnancy in the culdoscopy group, three years after tubectomy . To determine advantages and disadvantages of minilaparotomy and laparoscopy in managing patients affected by benign adnexal masses.
                Prospective, randomized, clinical trial on 127 patients affected by adnexal cysts. Patients were submitted to adnexal surgery through a laparoscopic or minilaparotomy approach on a random basis.
                Hundred and twenty-seven patients were enrolled in the study and randomly assigned to laparoscopy (63 patients) or minilaparotomy (64 patients). Characteristics of the patients and of the cysts were homogeneous between the two groups. No significant differences between the two groups were recorded in terms of operative time, intraoperative complications, ileus, length of stay and recovery time. The intraoperative rupture rate of the cyst was significantly higher in the laparoscopy group only in a subgroup of patients affected by cysts greater than 7 cm in diameter (p=0.01). Three patients randomized to laparoscopy required conversion to laparotomy. Concerning postoperative outcomes, postoperative pain and minor complications were significantly less in patients undergoing laparoscopy (p=0.001 and 0.04).
                Operative laparoscopy appears to be the preferable approach for the management of adnexal cysts. Minilaparotomy can be considered a mini-invasive approach as well, with acceptable operative and postoperative outcomes, and is a suitable alternative in case of contraindications to laparoscopy.
Major morbidity seems to be a rare outcome for both, laparoscopy and minilaparotomy. Personal preference of the woman and/or of the surgeon can guide the choice of technique. Practical aspects must be taken into account before implementing endoscopic techniques in settings with limited resources. Culdoscopy is not recommended as it carries a higher complication rate.