Minilaparoscopy in gynecology: applications, benefits and limitations

INTRODUCTION The word "minilaparoscopy" refers to laparoscopic surgical procedures performed using < 5-mm trocars, with the exception of the umbilical access. The aim of this review is to explore the feasibility of minilaparoscopy in gynecologic surgery, focusing on instruments, surgical techniques, application and limits of this approach. EVIDENCE ACQUISITION In this review the Authors discuss positive features and limitation of 3-mm laparoscopy for gynecologic surgery. EVIDENCE SYNTHESIS Using smaller trocars decreases incisional and postoperative pain, and shortens hospitalization, and provides a better cosmetic outcome. Transvaginal specimen extraction can be used to maximize the aesthetic outcomes. A minilaparoscopic surgical procedure is accomplished with lower carbon dioxide pressures, reducing pneumoperitoneum related complications. Accurate patient selection is critical in order to offer the best laparoscopic approach, considering that obesity and endometriosis may represent a challenge for 3-mm surgical tools, which are more flexible and have lower grasping ability. Minilaparoscopy has been shown as a valid alternative to conventional laparoscopy both for diagnostic purpose, major surgical procedures and oncological surgery. CONCLUSIONS Minilaparoscopy in gynecologic surgery represents an option for selected patients, for both benign and malignant indications. The aesthetic outcome represents the main benefit of this approach. Surgeons have to be aware of few limitations of this technique such as severe obesity and endometriosis.