SURGERY BY MINILAPAROTOMY IN BENIGN GYNECOLOGIC DISEASE

A new, minimally invasive technique for the management of benign gynec ologic disease is proposed. With the patient in a steep Trendelenburg position, access to the pelvis is gained through a minimal suprapubic incision (4-9 cm) beneath the pubic-hair line. The subcutaneous fat is incised in a cranial direction and the abdominal fascia is is opened 2-3 cm above the skin incision. The peritoneum is opened manually and two or three Deaver retractors replace the traditional self-retaining retractor. Continuous repositioning of the retractors permits the oper ative window to be focused always on the surgical field. This techniqu e can be performed only if the following criteria are met: use of narr ow and light instruments; exteriorization of the affected organs; comb ined, unidirectional maneuvering of all the retractors; and prompt hem ostasis by electrocoagulating forceps. Among 78 inpatients with benign gynecologic diseases who underwent surgical treatment with this appro ach, the feasibility rate was 96% and no intraoperative complications or severe postoperative morbidity were observed. Pelvic surgery by min ilaparotomy is a feasible and safe approach in the treatment of benign gynecologic disease.