GYNECOLOGIC ONCOLOGY 66, 138–140 (1997) ARTICLE NO. GO974738 The Feasibility of Open Laparoscopy in Gynecologic –Oncologic Patients J. Decloedt, M.D., P. Berteloot, M.D., and I. Vergote, M.D., Ph.D. 1 Gynecologic Oncology, University Hospitals Leuven, Gasthuisberg, Belgium Received November 14, 1996 this group of patients we performed an open laparoscopy Gynecologic–oncologic patients are at increased risk for compli- [15]. The technique of open laparoscopy [15], eliminating cations with closed laparoscopy. Open laparoscopy eliminates the blind insufflation and trocar insertion, has been used in our steps of blind insufflation and trocar insertion. This study is the department since 1994. This study is the first large series of first large series of open laparoscopies to assess the feasibility and open laparoscopies in patients with gynecologic malignan- safety of the open laparoscopy technique in patients with gyneco- cies and forms a critical evaluation of the feasibility and logic malignancies. We performed 90 open laparoscopies in 89 safety of this technique in comparison to the closed laparos- oncologic patients with previous majorsurgery (65%) and/orradio- copy technique. therapy (17%) ora large omental cake (18%). Complications due to the laparoscopic access technique occurred in one patient (1%) MATERIALS AND METHODS for whom a laparotomy was performed for a small bowel perfora- tion. The incidence of complications of the open laparoscopy tech- All patients operated with open laparoscopy between No- nique (1%) is favorable compared to the complication rate of closed laparoscopy in gynecologic–oncologic patients. It is concluded vember 1, 1994 and May 31, 1996 were analyzed. Medical that open laparoscopy is a safe and feasible technique in gyneco- records were reviewed with respect to previous surgery, ra- logic – oncologic patients.  1997 Academic Press diotherapy, indication for open laparoscopy, surgical proce- dure, peroperative visualisation, conversion to laparotomy, and complications. Only gynecologic – oncologic patients INTRODUCTION with previous surgery and/or radiotherapy or a large omental cake were included in the study. All patients in the group Indications for laparoscopy in patients with gynecologic with previous surgery had previous debulking surgery for malignancies are well documented in the literature including ovarian cancer or more than two laparotomies with vertical evaluation and selection for debulking surgery in patients incisions extending above or going through the umbilicus. with ovarian carcinoma [1 – 10], laparoscopic para-aortic All patients had a mechanical bowel preparation the day lymphadenectomy [2], laparoscopic-assisted radical vaginal before surgery. All patients received low-molecular-weight hysterectomy (Shauta), and laparoscopic radical abdominal heparin every 12 hr and prophylactic antibiotics 60 min be- hysterectomy for cervical carcinoma [11, 12] and laparo- fore the procedure. Laparoscopies were performed under scopic lymphadenectomy in combination with a laparo- general anesthesia with the patient in supine position. A scopically assisted vaginal hysterectomy (LAVH) in patients small vertical incision was made in the umbilicus and prefer- with stage I endometrial cancer [13]. ably outside the previous scar. The fat was dissected and However, some authors are concerned about the high risk the fascia was exposed with small Deaver retractors. The for bowel injuries with laparoscopy reported in 2–14% of fascia was incised vertically and the peritoneum was opened cases [3, 4, 6, 7, 9] and other complications such as vascular under direct vision. A 12-mm blunt-tip trocar (Origin) with injury [10] and metastases in the trocar insertion [8, 14]. an inflatable balloon at the tip was inserted. Insufflation was Patients with gynecologic malignancies often present with started immediately at a rate of 8 liters per minute at a previous multiple surgical interventions, radiotherapy, or a pressure of 15 mm Hg. Gas leakage from the pneumoperito- large omental cake and are therefore at increased risk for neum is prevented by compression of the abdominal wall complications when a closed laparoscopy is performed. In between the balloon and the rubber ring. All operations were performed with video endoscopic equipment. Secondary tro- car insertions were performed under direct laparoscopic vi- 1 To whom correspondence should be addressed. Fax: /32-16-344205. E-mail: Ignace.Vergote@uz.kuleuven.ac.be. sion. After the laparoscopy we closed the fascia with Vicryl 138 0090-8258/97 $25.00 Copyright  1997 by Academic Press All rights of reproduction in any form reserved.