Surgery by minilaparotomy in benign gynecologic disease.
A new, minimally invasive technique for the management of benign gynecologic 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 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 operative window to be focused always on the surgical field. This technique can be performed only if the following criteria are met: use of narrow and light instruments; exteriorization of the affected organs; combined, unidirectional maneuvering of all the retractors; and prompt hemostasis by electrocoagulating forceps. Among 78 inpatients with benign gynecologic diseases who underwent surgical treatment with this approach, the feasibility rate was 96% and no intraoperative complications or severe postoperative morbidity were observed. Pelvic surgery by minilaparotomy is a feasible and safe approach in the treatment of benign gynecologic disease.