The Impact of Minimal Access Surgery on Gynaecological Surgery in a University Gynaecological Unit Over a 10-Year Period from 1991 to 2000

FH Loh, N Hameed, SC Ng
Correspondence: Dr F H Loh, fh_loh@pacific.net.sg

ABSTRACT
Objective To assess the impact of minimal access surgery in replacing traditional open approach of surgery for benign gynaecological pathology.
Setting Gynaecological unit in a university hospital.
Methodology All surgical procedures for the treatment of ectopic pregnancy, benign ovarian cyst, myomectomy, and hysterectomy for benign gynaecological pathology over a 10-year period (1991 to 2000) were studied. The percentages of procedures performed with the minimal access approach were compared with the traditional open approach over the study period.
Findings The percentage of ectopic pregnancies treated laparoscopically has increased from a low of 27% in the initial two-year period of 1991-92 to stabilise at approximately 70% at the end of the decade. Laparoscopic approach for the treatment of benign ovarian cysts constituted just 31% of cases in the initial period (1991-92) and rose steadily to stabilise at approximately 50% of cases during the last four years of the decade. The proportion of advanced minimal access procedures such as myomectomy and hysterectomy increased at a more gradual pace during the decade. By 1999-2000, laparoscopic and hysteroscopic myomectomy constituted about 30% of all myomectomies but laparoscopic hysterectomy accounted for just about 5% of all hysterectomies performed.
Conclusion Minimal access surgery has largely replaced the open approach for the treatment of ectopic pregnancy and benign ovarian cysts. Advanced minimal access procedures such as myomectomy and hysterectomy showed a rising trend through the decade, but still accounted for a minority of procedures at the end of the decade.

Keywords: Gynaecological Surgery, Laparoscopy, Hysteroscopy
Singapore Med J 2002; 43(4): 177-181