title: Laparoscopically guided minilaparotomy: a minimally invasive approach for the treatment of gynaecologic diseases in morbidly obese patients.
abstract: OBJECTIVE
  Obese patients are at greater risk of gynaecologic surgery. Laparotomy is generally performed, even though this approach is regarded as highly invasive, whereas laparoscopy, though minimally invasive, is relatively contraindicated because of the high conversion rates to laparotomy. In light of this, we propose laparoscopically guided transverse minilaparotomy (LGTM) as a minimally invasive alternative technique. The rationale of diagnostic laparoscopy is to evaluate the feasibility of a minimally invasive approach. We have evaluated the feasibility and compared the outcomes with a historical group treated with laparotomy (LPTM), in morbidly obese patients (MOP) subjected to gynaecologic surgery.
  
  
  METHODS
  From November 2004, MOPs with body mass index (BMI) ≥ 40 kg/m² and admitted for gynaecologic surgery (early stage endometrial cancer and benign disease) were enrolled in this observational study and submitted to LGTM. Patients with a uterine size greater than the umbilical transverse line and with indication for vaginal surgery were excluded operative data and outcome were prospectively recorded.
  
  
  RESULTS
  LGTM was feasible in 34 cases (87%) out of 39. In two women, the procedure was aborted due to intraperitoneal and ovarian malignant disease spread diagnosed at laparoscopy. In three cases, conversion was necessary due to severe adhesions in one case; laparoscopically unrecognized disease spread in the parametria in the second, and in the remaining case a right common iliac vein injury during lymphadenectomy. When compared to LPTM, haemoglobin drop and postoperative stay were significantly reduced with LGTM. Complications were higher in the control group: due to a significantly higher incidence of wound dehiscence (OR 0.27, 95% CI 0.05-1.32, p<0.05).
  
  
  CONCLUSIONS
  LGTM is feasible in the vast majority of MOPs and achieves significantly better results when compared to the standard approach.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Rome Sapienza, Via del Policlinico, 155 - 00187 Rome, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Benedetti Panici
authors.forename: Giorgia
authors.initials: G
authors.lastname: Perniola
authors.forename: Milena
authors.initials: M
authors.lastname: Pernice
authors.forename: Morena
authors.initials: M
authors.lastname: Antonilli
authors.forename: Chiara
authors.initials: C
authors.lastname: Achilli
authors.forename: Violante
authors.initials: V
authors.lastname: Di Donato
authors.forename: Filippo
authors.initials: F
authors.lastname: Bellati
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005831:Genital Diseases, Female / Q000150:complications* / Q000601:surgery*; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D007813:Laparotomy / Q000009:adverse effects* / Q000379:methods; D007902:Length of Stay; D008875:Middle Aged; D009367:Neoplasm Staging; D009767:Obesity, Morbid / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D013529:Surgical Wound Dehiscence / Q000453:epidemiology / Q000517:prevention & control