Minilaparotomy vs laparoscopic hysterectomy for benign gynaecological diseases

Postoperative complications and unanticipated healthcare encounters following mini-laparotomy vs. laparoscopic/robotic-assisted sacrocolpopexy: a comparative retrospective study

BACKGROUND

Pelvic organ prolapse is a debilitating condition impacting lives of millions of women worldwide. Sacrocolpopexy (SCP) is considered an effective and durable surgical technique for treatment of apical prolapse. The aim of this study was to compare short-term outcomes including postoperative complications and unanticipated healthcare encounters between patients who underwent SCP with a mini-laparotomy approach compared to patients treated with laparoscopic and robotic-assisted laparoscopic SCP.

METHODS

This was a retrospective cohort study including patients treated for apical prolapse at a university affiliated urogynecology practice. Patients over the age of 18 who underwent abdominal SCP between 2019 and 2023 were included. The cohort was formed into two groups: (1) Patients who underwent SCP through a mini-laparotomy incision (Mini-lap group); (2) Patients who underwent laparoscopic or robotic-assisted laparoscopic SCP (Lap/Robot group).

RESULTS

A total of 116 patients were included in the final analysis. Ninety patients underwent either laparoscopic or robotic-assisted SCP, whereas 26 patients underwent SCP with a mini-laparotomy approach. Study participants exhibited a mean age of 63.1 ± 10.3 years, mean body mass index (BMI) of 25.8 ± 4.9 Kg/m2, and 77.6% of them identified as Caucasian. Upon comparison of demographic and past medical history between groups there were no statistically significant differences in age, BMI, menopausal status, race, parity or comorbid conditions. Patients in the Mini-lap group were less likely to have undergone previous abdominal surgery (11.5% vs. 50.6%, p < 0.001) and had more severe apical prolapse (stage 4 prolapse, 40% vs. 21.2%, p < 0.001) than their counterparts in the Lap/robot group. Regarding intraoperative parameters, length of surgery was significantly shorter in the Mini-lap group compared to the Lap/robot group (97.3 ± 35.0 min vs. 242.0 ± 52.6 min, p < 0.001). When focusing on the primary outcome, postoperative complications within the first 30 days after surgery, there were no differences noted between groups. Additionally, the number of unanticipated healthcare encounters, such as phone calls, clinic visits, emergency department visits, urgent care visits, readmissions and reoperations were similar between groups.

CONCLUSIONS

Mini-laparotomy approach for SCP is safe with comparable intra- and postoperative complications, and unanticipated healthcare encounters compared to conventional minimally invasive methods.

Gynecologic Surgery during the COVID-19 Pandemic: Is Universal Screening Mandatory?

This study is aimed at evaluating the results of the universal preoperative screening for COVID-19 in gynecologic cases operated on during its outbreak in a tertiary care hospital in Bangkok, Thailand. A retrospective descriptive study was done on all patients who underwent elective or emergency gynecologic surgeries during the pandemic period in Thailand (April 15 to June 5, 2020). The COVID-19 screening results by symptom-based screening, risk-based screening, and RT-PCR for COVID-19 were collected from the electronic medical records. Among 129 patients who underwent gynecologic surgeries, none had a positive RT-PCR for COVID-19. Symptom-based screening found no patients with positive symptoms for COVID-19. Risk-based screening found 4 patients (3.1%) who were in contact with suspected or confirmed COVID-19 cases and 4 patients (3.1%) who were healthcare personnel. In conclusion, routine preoperative RT-PCR for COVID-19 may need to be reconsidered among asymptomatic individuals in a low-prevalence country during the well-controlled COVID-19 situation. Larger studies are required to ascertain the benefit of universal preoperative COVID-19 testing.