Perspectives on laparoscopy in gynecologic oncology: patient selection key.(Gynecology)

KEY LARGO, FLA. -- Operator experience and careful patient selection are keys to successful use of laparoscopy for gynecologic oncology, according to Dr. Luis E. Mendez.

He gave his perspective on the advantages, disadvantages, and potential errors associated with laparoscopy for patients with adnexal masses, lymphadenectomy, endometrial cancer, and cervical cancer at an ob.gyn. update sponsored by the University of Miami.

Survival rates after laparoscopy and traditional open surgery are about the same, Dr. Mendez said, but complication rates from laparoscopy can be relatively high, and the procedure can be more costly.

"A laparoscopic radical hysterectomy increases operative time by 3 hours, and you're using disposable instrumentation. The costs may not offset the reduction in hospital stay," said Dr. Mendez of the Division of Gynecologic Oncology, University of Miami.

Advantages of laparoscopy include less postoperative pain, a better cosmetic result, and a lower rate of adhesion formation. The disadvantages stem from inexperience of the operating surgeon and include anatomical misidentification and technique errors.

Contraindications of laparoscopy include advanced intrauterine pregnancy, a large abdominal mass, bowel obstruction, and irritable bowel disease. Extremely large or small patients are relative contraindications.

Laparoscopy may be considered for patients with the following conditions: