title: Retrospective Cohort Study to Assess Outcomes, Cost-Effectiveness, and Patient Satisfaction in Primary Vaginal Ovarian Cystectomy versus the Laparoscopic Approach.
abstract: OBJECTIVE
  To compare surgical outcomes, cost-effectiveness, and patient satisfaction in women undergoing primary vaginal or laparoscopic ovarian cystectomy for benign ovarian cysts.
  
  
  METHODS
  Retrospective cohort control study (Canadian Task Force classification II-3).
  
  
  METHODS
  Gynecologic unit at a university-affiliated hospital.
  
  
  METHODS
  Fifty patients who underwent primary ovarian cystectomy either through the vaginal route via posterior colpotomy (n = 29) or laparoscopic route (n = 21).
  
  
  METHODS
  Nonmalignant ovarian cysts were initially determined by transvaginal ultrasonography and serum tumor markers. The index group of women (n = 29) underwent vaginal ovarian cystectomy via a posterior colpotomy incision, whereas the control group (n = 21) comprised women who had laparoscopic ovarian cystectomy using the traditional "grasp and peel" technique. The following outcomes were evaluated: duration of surgery, intraoperative complications, estimated blood loss, length of inpatient stay, and postoperative pain (visual analogue scale). The average cost of both surgical methods was calculated by factoring in theater time, equipment required, and the length of hospital stay. Patients were then surveyed to compare postoperative pain and satisfaction scores as well as the time taken to return to work (in days).
  
  
  RESULTS
  The 2 groups had similar mean ages (35.79 vs 36.72 years) and cyst diameter (6.8 vs 6.6 cm) (p > .05 in both cases). Vaginal ovarian cystectomy took a mean of 13.7 minutes longer (91.7 vs 78.0 minutes, p < .001) to perform and resulted in a greater mean estimated blood loss (116.1 vs 95 mL, p < .001). The spillage rate in the index group was 6-fold less compared with control cases (6% ± 2.4% vs 35% ± 4.6, p < .01). Although patients from the index group spent a mean of 2 hours longer as inpatients (10.9 vs 8.9 hours, p < .001), they reported a lower mean visual analogue pain score (2.01/10 vs 3.95/10, p < .05) and higher patient satisfaction scores (8.2/10 vs 6.5/10, p < .001). Mean perioperative cost of women who underwent vaginal ovarian cystectomy was lower (£1690.13 vs 1761.67) and they returned to work quicker compared with the laparoscopic group (13.6 vs 39.2 days, p < .001).
  
  
  CONCLUSIONS
  Vaginal ovarian cystectomies took longer to perform and led to longer inpatient stay. However, these women had less postoperative pain and reported higher satisfaction scores compared with laparoscopic ovarian cystectomy, with a quicker return to work. The vaginal approach is a viable and cost-effective alternative to the laparoscopic approach in carefully selected patients.
authors.affiliation: Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, United Kingdom. Electronic address: waiyoong@nhs.net.
authors.forename: Wai
authors.initials: W
authors.lastname: Yoong
authors.affiliation: University College London Medical School, London, United Kingdom.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fadel
authors.affiliation: Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, United Kingdom.
authors.forename: Sophie
authors.initials: S
authors.lastname: Walker
authors.affiliation: Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, United Kingdom.
authors.forename: Sophie
authors.initials: S
authors.lastname: Williams
authors.affiliation: Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, United Kingdom.
authors.forename: Beena
authors.initials: B
authors.lastname: Subba
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery; D010535:Laparoscopy / Q000379:methods; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010048:Ovarian Cysts / Q000473:pathology / Q000601:surgery*; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000517:prevention & control* / Q000601:surgery; D012189:Retrospective Studies
keywords: Cost-effectiveness; Laparoscopy; Patient satisfaction; Postoperative outcomes; Vaginal ovarian cystectomy