title: The utility of hand-assisted laparoscopy in ovarian cancer.
abstract: BACKGROUND
  The traditional approach to patients with ovarian cancer is cytoreductive surgery and surgical staging through a vertical midline laparotomy. While laparoscopy has become an integral part of gynecologic surgery, debulking procedures have not been feasible to date with standard minimally invasive techniques.
  
  
  METHODS
  Twenty-five patients with ovarian carcinoma underwent surgical staging and cytoreduction using hand-assisted laparoscopy. We review the surgical technique and clinical outcomes.
  
  
  RESULTS
  Twenty-five patients were managed during this study time frame with hand-assisted laparoscopy. Six patients had apparent advanced stage ovarian cancer at the time of referral, and 17 patients had apparent early-stage ovarian cancer. Of the 19 patients with presumed early-stage disease, 5 patients were upstaged based on retroperitoneal lymph node involvement, 3 with disease to other pelvic structures, and 2 patients had microscopic disease in the omentum. Twenty-two patients had their surgeries completed via hand-assisted laparoscopy, and three cases required conversion to laparotomy for completion of debulking surgery. Complication rates were low with three complications requiring reoperation or hospitalization. The mean hospital stay was 1.8 days for the 22 patients who had a successful hand-assisted laparoscopic evaluation. Operating times were variable and ranged from 81 to 365 min.
  
  
  CONCLUSIONS
  Hand-assisted laparoscopy may be employed in the initial management of early and advanced stage ovarian carcinoma. This approach allows for thorough evaluation of peritoneal and retroperitoneal structures and surgical cytoreduction while retaining the advantages of minimally invasive surgery.
authors.affiliation: Daivid Grant Medical Center, Ob/Gyn, 224 Lone Oak DR, Vacaville, CA 95688, USA. tomkrivak@aol.com
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Krivak
authors.forename: John C
authors.initials: JC
authors.lastname: Elkas
authors.forename: G Scott
authors.initials: GS
authors.lastname: Rose
authors.forename: Michael
authors.initials: M
authors.lastname: Sundborg
authors.forename: William E
authors.initials: WE
authors.lastname: Winter
authors.forename: Jay
authors.initials: J
authors.lastname: Carlson
authors.forename: Paul J
authors.initials: PJ
authors.lastname: MacKoul
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies