Use of laparoscopy in older women undergoing gynecologic procedures: is it time to overcome initial concerns?

Abstract

Objective: The aim of this study was to analyze temporal trends in adoption of laparoscopy in a cohort of older women (> or =70 y) undergoing gynecologic abdominal procedures and to assess operative outcomes compared with those of open procedures.

Methods: A prospective entered database was queried for all women aged 70 years or older undergoing surgery at our department during a 9-year period. Surgical outcomes were compared according to the type of surgical approach (laparoscopy vs open) and assessed over time.

Results: Two-hundred thirty-one women were identified. Of these, 116 underwent laparoscopic procedures, and 115 had open abdominal surgery. The study groups were similar with regard to demographics and preoperative variables. Conversion to laparotomy due to intervening complications occurred in one case (0.9%). Among women with early-stage gynecologic malignancies, overall and postoperative complications were lower in the laparoscopy group than in the open surgery group. Estimated blood loss and hospital stay were lower in the laparoscopy group than in the open surgery group, for both benign and malignant conditions. The annual proportion of laparoscopic cases has increased significantly during the study period from 12% in 2001 to 79.3% in 2007 (P for trend < 0.0001). No difference was found in operative time, number of lymph nodes harvested, and complication rates, when data of subsequent time periods were compared.

Conclusions: Older women who undergo laparoscopy have a significantly shorter hospitalization and fewer complications compared with older women who undergo open surgery. Laparoscopy should be considered in all women in whom a gynecologic abdominal procedure is planned regardless of age.