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At least 19 recordsLinked to original sources

PubMed1998

Incidence of deep vein thrombosis after laparoscopic vs minilaparotomy cholecystectomy.

OBJECTIVES: To determine the frequency of deep vein thrombosis (DVT) associated with minimally invasive cholecystectomy and to determine, using minilaparotomy cholecystectomy as a control operation, the influence of the laparoscopic pneumoperitoneum on DVT formation. DESIGN: Prospective nonrandomized control trial. SETTING: Tertiary care university hospital. PATIENTS: One hundred consecutive patients intended to undergo either laparoscopic cholecystectomy (59 patients) or minilaparotomy cholecystectomy (41 patients) with either of 2 surgeons were prospectively enrolled between April 1996 and April 1997. The minilaparotomy cholecystectomy group served as controls to isolate the effect of the pneumoperitoneum. Patient details, operative details, and any thromboembolic or bleeding complications were recorded. The same thromboprophylaxis regimen was prescribed for each group; namely, preoperative and postoperative subcutaneous low-molecular-weight heparin (LMWH), graduated compression stockings, and intraoperative intermittent calf compression. INTERVENTION: Minimally invasive cholecystectomy. MAIN OUTCOME MEASURE: Frequency of DVT. Bilateral lower limb venous color duplex scanning was used to detect DVT. Scans were performed on 3 occasions: (1) preoperatively on admission to hospital, (2) on the first postoperative day, and (3) between 2 and 4 weeks postoperatively. RESULTS: Three patients in the laparoscopic group and 2 patients in the minilaparotomy group underwent conversion to conventional open cholecystectomy. There were no significant differences between patients in the 2 groups for age, sex, body mass index, preoperative white blood cell count, platelet count, prothrombin time, or activated partial thromboplastin time. There were no significant differences between the 2 groups for elective vs emergency operations, public hospital vs private hospital admissions, or consultant vs resident surgeon. Macroscopic gallbladder pathology grades for both groups were not significantly different, and there was no significant difference in the duration of postoperative hospital stay. Operative cholangiography was performed in a significantly larger proportion of laparoscopic cases (86% vs 66% in the minilaparotomy group; chi(2) test, P=.002), and the duration of anesthesia was significantly longer for the laparoscopic operation (118 minutes vs 98 minutes; t test, P=.05). Ninety-seven patients received preoperative LMWH and all patients received graduated compression stockings, intraoperative intermittent calf compression, and postoperative LMWH. Two of the 100 patients had postoperative DVT, 1 after laparoscopic cholecystectomy and 1 after minilaparotomy cholecystectomy. Both DVTs were detected by duplex examination on the first postoperative day. The DVT found after laparoscopic cholecystectomy was in 1 of the 3 patients who did not receive preoperative LMWH. There were no DVTs in any of the 40 patients who had an additional duplex scan between 2 and 4 weeks after operation. CONCLUSIONS: Despite the theoretical risk of thromboembolic disease due to use of the laparoscopic pneumoperitoneum, the frequency of DVT after either laparoscopic cholecystectomy or minilaparotomy cholecystectomy is low if adequate thromboprophylaxis is provided.

Cholecystectomy, Laparoscopic↗

PubMed2000

Minilaparotomy and endoscopic techniques for tubal sterilisation.

OBJECTIVES: To evaluate laparoscopic tubal sterilisation, as compared to minilaparotomy in terms of operative morbidity and mortality. Trials comparing laparoscopy or minilaparotomy with culdoscopy were also included in the review. Different methods used to interrupt tubal patency (excision, occlusion and coagulation) and comparison of different forms of anaesthesia will be considered in different reviews. SEARCH STRATEGY: Randomised controlled trials (RCTs) have been identified by using the search strategy of the Cochrane Collaboration. The Cochrane Controlled Trials Register has been searched. Reference lists of identified trials have been searched. SELECTION CRITERIA: All randomised controlled trials comparing laparoscopy, minilaparotomy and/or culdoscopy for tubal sterilisation. Except in one trial [Taner 1994] where 4 women underwent curettage at the same time, all women requested tubal sterilisation as an interval procedure. DATA COLLECTION AND ANALYSIS: Trials under consideration were evaluated for methodological quality and appropriateness for inclusion. Data were extracted independently by the reviewers. Results are reported as odds ratio for dichotomous outcomes and weighted mean differences for continuous outcomes. MAIN RESULTS: Minilaparotomy vs laparoscopy: There was no difference in major morbidity between the 2 groups. Minor morbidity was significantly less in the laparoscopy group (Peto OR 1.89; 95% CI 1.38, 2.59). Duration of operation was about 5 minutes shorter in the laparoscopy group (WMD 5.34; 95% CI 4. 52, 6.16). Minilaparotomy vs culdoscopy: Women undergoing culdoscopy had more major morbidity than women for whom minilaparotomy was performed (Peto OR 0.14; 95% CI 0.02, 0.98). Duration of operation was about 5 minutes shorter in women undergoing culdoscopy (WMD 4. 91; 95% CI 3.82, 6.01). Laparoscopy vs culdoscopy: In the one trial comparing the two interventions there were no significant differences between the groups with regard to major morbidity. Significantly more women suffered from minor morbidities in the culdoscopy group compared to the laparoscopy group (Peto OR 0.20; 95% CI 0.05, 0.77). REVIEWER'S CONCLUSIONS: Major morbidity seems to be a rare outcome for both, laparoscopy and minilaparotomy. The included studies had limited power to demonstrate significant differences especially for the relatively rare but potentially serious outcomes. Personal preference of the woman and/or of the surgeon can guide the choice of technique. Practical aspects (e.g. cost, maintenance, and sterilisation of the instruments) must be taken into account before implementing the more sophisticated endoscopic techniques in settings with limited resources. Culdoscopy is not recommended as it carries a higher complication rate.

Female↗

PubMed1994

Pomeroy tubal ligation by laparoscopy and minilaparotomy.

Pomeroy tubal ligation is a widely-used method for surgical female sterilization. A laparoscopic technique of Pomeroy tubal ligation using endoloop sutures is compared with the conventional technique of Pomeroy tubal ligation by minilaparotomy. Forty-four women requiring sterilization were randomly selected for either laparoscopy (n = 24) or minilaparotomy (n = 20). Mean operative time in the laparoscopy group (18.90 +/- 5.56 with a range of 12-35 minutes) was not significantly different from that in the minilaparotomy (23.12 +/- 8.24 with a range of 15-45 minutes) group. In all women, tubal specimens confirmed tubal histology. Both laparoscopy and minilaparotomy procedures may be performed for Pomeroy tubal ligation with minor morbidity. In clinics with appropriate conditions, Pomeroy tubal ligation by laparoscopy may be preferable to minilaparotomy.

Adult↗

PubMed1996

Laparoscopic-assisted and minilaparotomy approaches to colorectal diseases are similar in early outcome.

OBJECTIVE: The purpose of this study was to compare laparoscopy with minilaparotomy approaches to colorectal diseases. METHOD: Outcomes after minilaparotomy and laparoscopy were prospectively compared for a 12-month period. RESULTS: Minilaparotomy was performed in 35 patients to achieve right colectomy (14), left colectomy (8), total colectomy (2), low anterior resection (6), abdomino-perineal resection (2), colostomy (1), and ileal resection (1). Laparoscopic techniques were used in 52 patients to perform right colectomy (20), left colectomy (11), low anterior resection (5), abdominoperineal resection (7), total colectomy (3), ileal resection (1), colostomy (3), transverse colectomy (1), and colostomy closure (1). Mean operative times were 69 minutes for minilaparotomy (range, 33-180) and 173 minutes for laparoscopy (range, 60-300). Mean incision lengths were 12 (range 8-18) cm and 8 (range, 0-25) cm; mean time to bowel movement was four (range, 1-7) days and 3.9 (range, 0-8) days; mean day of discharge was 6.9 (range 3-15) days, and 6 (range, 1-15) days postoperatively, respectively. Laparoscopy procedures were completed in 39 of 52 patients (75 percent); mean time to bowel movement was 3.5 (range, 0-6) days, and mean day of discharge was 5.3 (range, 1-14) days (P = <0.005). CONCLUSION: The use of a small incision, whether by minilaparotomy or by laparoscopy, results in similar early return of function and discharge.

Adult↗

PubMed1998

Minilaparotomy hysterectomy.

OBJECTIVE: This article reports our experience with minilaparotomy hysterectomy. STUDY DESIGN: Minilaparotomy was defined as a skin incision < or = 6 cm in length. From January 1, 1996, to June 30, 1997, data were collected on all patients who underwent hysterectomy by means of a minilaparotomy. RESULTS: During the study a total of 250 hysterectomies were performed. Twenty-six of those were performed by means of a minilaparotomy. The mean age of the patients was 54 years. Seven had endometrial cancer and 8 had an adnexal mass. In 1 patient the incision was extended for staging of an ovarian cancer. The only intraoperative complication was rupture of a 6-cm ovarian tumor. After operation, 2 patients had febrile morbidity, 1 had a prolonged ileus, and in 1 atrial fibrillation developed. The mean uterine weight was 123 g. Median day of Foley catheter removal and mean day of ambulation, regular diet, and discharge were 1 day, 1.2 days, 2.4 days, and 3.4 days, respectively. CONCLUSION: Minilaparotomy is a safe and feasible route of hysterectomy for a selected group of patients.

Adult↗

PubMed1998

[Cholecystectomy using a minilaparotomy].

Recent randomized studies have shown that laparoscopic cholecystectomy has little or even no advantage when compared to minilaparotomy cholecystectomy. The authors report the results of a prospective study of minilaparotomy performed at Dahr el Bacheq governmental hospital where laparoscopic equipment was not available. From July 1994 to July 1997 minilaparotomy cholecystectomy was performed on one hundred consecutive patients (75 women and 25 men with an age varying between 26 and 93 years). However, the cholecystectomy could be accomplished through the mini-incision in only 88 cases. Lengthening of the incision was necessary in 12 cases: common duct stones (8 cases), cancer (2 cases), cholecystoduodenal fistula (2 cases). Intraoperative cholangiography was not performed in 3 cases: very thin cystic duct (2 cases), technical problem (1 case). Two patients operated for acute cholecystitis had wound infection. Postoperative course of the 88 completed minilaparotomy cholecystectomies was uneventful: no mortality, no biliary complications, little pain with low analgesia requirement, oral intake on day 1, discharge from hospital on day 2, return to normal activity between day 8 and day 14. Results of minilaparotomy cholecystectomy compare favorably with those of laparoscopic cholecystectomy. It should be an alternative to laparoscopic cholecystectomy especially when cost is a problem or when laparoscopic equipment is not available and an alternative to conventional open cholecystectomy in the case of contraindication to laparoscopic cholecystectomy.

Acute Disease↗

PubMedDate not supplied

A comparative study of the tubal ring applied via minilaparotomy and laparoscopy in postabortion cases.

Sterilization with tubal rings applied via minilaparotomy or laparoscopy was performed on 300 randomly selected postabortion subjects to evaluate the safety and effectiveness of the two surgical methods. One hundred and forty-nine procedures were performed by minilaparotomy and 151 by laparoscopy. Gas leakage due to equipment problems was the most common technical difficulty during laparoscopy, and difficulty in exteriorizing the tubes was the most common surgical difficulty. Women undergoing laparoscopy experienced significantly less pain during surgery and had significantly lower rates of immediate and early postoperative complications than those women undergoing minilaparotomy. The rates of gynecologic abnormalities at six and 12 months were similar for both procedures. At this writing, no pregnancies have been reported among the study subjects. The results of our study indicate that laparoscopy is superior to minilaparotomy when it is performed in a controlled hospital situation.

Abortion, Induced↗

PubMed1998

Minilaparotomy approach to tumors of the right colon.

OBJECTIVE: The study contained herein was undertaken to describe the minilaparotomy approach to tumors of the right colon. METHOD: Clinical data were prospectively registered from 47 patients who were undergoing resection of the right colon via minilaparotomy. RESULTS: Bowel function returned after two days and passage of stools after four days. Pain medication was necessary only during the first three postoperative days. Major complications were few, and no postoperative deaths occurred. Tumors 10 cm or smaller could be handled by minilaparotomy, and the technique allowed a relevant number of lymph nodes to be removed. No local recurrences were detected during the early postoperative period. CONCLUSION: The minilaparotomy approach to tumors of the right colon seems to be an attractive alternative to conventional colon surgery.

Aged↗

PubMed1982

Randomized comparative study of culdoscopy and minilaparotomy for surgical contraception in women.

Informed, healthy, volunteering women seeking interval sterilization were randomly allocated either to culdoscopy or to minilaparotomy. Data concerning the operation and follow-up to six weeks post-operation were analyzed for 199 women in the culdoscopy group and 196 in the minilaparotomy group. Major complications, both at operation and subsequently, occurred only in the vaginal procedure group (3%). Minor complications occurred in 3.6% of women in the minilaparotomy group, the majority of these involving the abdominal wound. In the women operated vaginally, minor complications occurred in 1.5%. Failure to perform the intended procedure on the fallopian tubes occurred in 10.6% of culdoscopy cases and 0.5% of minilaparotomy cases. It is concluded that the vaginal approach cannot be recommended except for surgeons experienced in vaginal surgery.

Adult↗

PubMed1994

Improvement of Minilaparotomy Technique to Allow for Reversal of Extensive Sterilization Procedures

In a previous study of outpatient reversal of tubal sterilization by a combined approach of laparoscopy and minilaparotomy, postoperative intrauterine pregnancy rates were 71%, and total costs were 40% lower than for those women undergoing anastomosis by a traditional laparotomy. However, the technique, which involved exteriorization of the uterus and adnexa, could not be easily applied when difficult cases with little remaining oviduct were encountered. With a modification of technique and the addition of a new retractor, it became feasible to consider more difficult cases for minilaparotomy outpatient reversal of sterilization. We prospectively studied 11 such patients with weight < IBW + 30% and < 4 cm of operable oviduct for technical feasibility, cost, complication rates, and reproductive outcome. A vaginal pack was used to elevate the uterus and a Babcock clamp was used to bring the fundus toward the incision by traction on the round ligament. A small self-retaining retractor designed for back surgery (Cloward retractor) was used for the abdominal wall. With the aid of an operating microscope a two-layer anastomosis was performed with 7-0 and 9-0 polydiaxone sutures. In all cases minilaparotomy reversal of tubal sterilization could be performed without prolonged technical difficulty. The mean age of the patients was 34.1 years (range 25-41 years) and operating time 110 minutes (87-158 min). There were no intraoperative or perioperative complications during the same day hospitalization. The mean time of follow-up was 16.7 months. Postoperatively, five women had ongoing or delivered pregnancies (45%) and one woman had two ectopic pregnancies. This study demonstrated a method for outpatient reversal of extensive tubal sterilization which was technically feasible in the 11 attempted patients. Based on the preliminary data from this study we encourage patients who have had extensive tubal sterilization procedures to consider both outpatient, minilaparotomy anastomosis and IVF as reasonable alternatives.

Journal Article↗

PubMed1998

Minilaparotomy radical retropubic prostatectomy: technique and results.

PURPOSE: A small incision (minilaparotomy) radical retropubic prostatectomy is described and evaluated. A newly designed self-retaining retractor was used as a robot and functioned as a second operative assistant. MATERIALS AND METHODS: A total of 522 consecutive patients underwent minilaparotomy radical prostatectomy by a single surgeon (F. F. M.) between 1991 and 1997. The technique of minilaparotomy radical retropubic prostatectomy (a 7 to 8 cm. midline incision) is described in detail. RESULTS: A questionnaire was mailed to all 522 patients and there were 265 responses. Satisfactory continence was achieved in the short term in 85% of patients (0 to 1 pad). Of the patients 83% had a prostate specific antigen of less than 0.2 ng./ml. at average followup of 2.6 years. There was no operative mortality and the overall complication rates were similar to other patients treated by the same department staff with a larger incision. The typical patient was discharged home 3 days postoperatively. CONCLUSIONS: Minilaparotomy radical retropubic prostatectomy compares favorably with standard radical retropubic prostatectomy.

Equipment Design↗

PubMed1997

Postoperative intravenous drip infusion is not required after minilaparotomy cholecystectomy.

OBJECTIVE: To determine if drip infusion should be discontinued after full recovery of the patient from anaesthesia after minilaparotomy cholecystectomy in uncomplicated cases. DESIGN: A randomised controlled clinical trial on 60 patients, from the waiting list, of cholelithiasis/cholecystitis operated by minilaparotomy cholecystectomy between November 1995 to March 1996. 30 patients did not receive postoperative i.v. drip infusion and in 30 patients 12-24 hours of standard drip transfusion was continued according to the current practice. SETTING: Single Surgical Unit, SS Hospital, Banaras Hindu University, Varanasi, India. MAIN OUTCOME MEASURE: Recognition of clinical indication for continuation of i.v. drip infusion after full recovery from anaesthesia. RESULTS: In the cohorts of 30 patients each who were or were not given i.v. drip infusion after full recovery from anaesthesia following minilaparotomy cholecystectomy the observations on pulse rate, blood pressure, time to first voiding of urine and time to start first oral intake of fluids were identical. However postoperative urinary retention occurred in 6 (20%) patients in whom the IV drip infusion was given. CONCLUSION: There is no clinical indication to continue IV drip infusion after full recovery from anaesthesia in patients operated for minilaparotomy cholecystectomy.

Adult↗

PubMed1999

Laparoscopy-assisted urologic surgery through minilaparotomy.

Minimally invasive surgery has gained wide acceptance as a method of reducing postoperative pain and curtailing the convalescence period. We have devised a modified surgical technique of laparoscopy-assisted surgery through minilaparotomy. It is a hybridized form of conventional open and laparoscopic surgery and it combines the benefits of both techniques by reducing postoperative pain and scarring as in laparoscopy, but at the same time maintaining the safety of conventional open surgery. From January 1992 to September 1999, we performed laparoscopy-assisted surgery through minilaparotomy in 167 patients. The operative time for laparoscopy-assisted surgery through minilaparotomy ranged from 79 to 290 minutes (mean 125). There was no conversion to open surgery, no peri- or postoperative complications, and only 3 patients needed a blood transfusion at any stage. Pain was significant on the first day but resolved quickly. All patients resumed consistent oral intake on the second day. All patients commenced ambulation by the second postoperative day and were able to resume full ambulatory activity by the fourth postoperative day. The final would size did not exceed 10 cm in size and all patients expressed satisfaction with their wounds. In conclusion, we believe that laparoscopy-assisted minilaparotomy surgery is a truly minimally invasive technique maintaining the advantages of conventional surgery. Our method could become a first-line approach for simple nephrectomy, living donor nephrectomy and radical nephrectomy, as well as surgery for kidney and ureter stones.

Adolescent↗

PubMed1999

Outpatient minilaparotomy for ovarian cysts.

OBJECTIVE: To design an operative procedure for the ambulatory management of ovarian cysts using classical surgical techniques. STUDY DESIGN: One hundred consecutive patients 55 years old or younger with 115 persistent or complex ovarian cysts less than 10 cm in diameter were managed as outpatients by minilaparotomy. Minilaparotomy is defined as a transverse or vertical incision 3-5 cm in length. The procedure and anesthetic were dictated by each clinical situation. Bupivacaine HCl with epinephrine was injected in the wound preemptively, and ketorolac was administered systemically perioperatively. Operative times, complications and pathology were determined for each case. RESULTS: The procedures (unilateral cystectomy, 65; bilateral cystectomy, 9; unilateral salpingo-oophorectomy, 20; and bilateral salpingo-oophorectomy, 6) were performed under general endotracheal anesthesia in 89, laryngeal mask anesthesia in 5 and spinal block in 6. Mean operative time was 46 minutes. Estimated blood loss in 96% of cases was < 50 mL, and none was > 100 mL. Pathology in two cases revealed adenocarcinoma of borderline malignancy. Remaining histology included endometrioma, 40; dermoid, 25; serous cystadenomas, 14; hemorrhagic corpus luteum, 9; mucinous cystadenoma, 8; cystadenofibroma, 7; follicular cyst, 3; fibrothecoma, 2; and peritoneal inclusion cyst, 1. Ninety-six of 100 patients were discharged on the day of surgery. Two were admitted for urinary retention, one for severe nausea and vomiting, and one for diabetes control. CONCLUSION: Minilaparotomy is a safe, rapid procedure for the management of ovarian cysts on an ambulatory basis. It can be performed under regional anesthesia, avoids intraperitoneal spill and requires only basic operative techniques and instrumentation. Minilaparotomy is also a cost-effective technique for outpatient management of ovarian cysts.

Adult↗

PubMed1982

Minilaparotomy or laparoscopy for sterilization: a multicenter, multinational randomized study. World Health Organization, Task Force on Female Sterilization, Special Programme of Research, Development and Research Training in Human Reproduction.

A multicenter, multinational randomized comparison of minilaparotomy and modified Pomeroy tubal ligation and laparoscopy with tubal electrocoagulation for interval sterilization of women was conducted in eight centers. Results were analyzed for 791 women in the minilaparotomy group and 819 in the laparoscopy group. Major complications occurred in 1.5% of women in the former group and 0.9% in the latter. Technical problems or major anesthetic complications occurred in 0.5% of subjects undergoing minilaparotomy and 0.9% of subjects undergoing laparoscopy. For minor complications the figures were 11.6% and 6.0%, respectively, while for minor complaints the rates were 34.1% and 26.5%, respectively. It is concluded that the two methods of approach to the fallopian tubes are similar in their complication rates. Because of its more simple requirements in terms of equipment and training, minilaparotomy is the preferred approach for services provided away from a major institution.

Adult↗

PubMed1998

Microsurgical tubal anastomoses performed as an outpatient procedure by minilaparotomy are less expensive and as safe as those performed as an inpatient procedure.

OBJECTIVE: To determine the cost-effectiveness, safety, and success of microsurgical tubal anastomoses performed by minilaparotomy as an outpatient. DESIGN: Retrospective. SETTING: Military tertiary care medical center. PATIENT(S): Seventy consecutively seen women of reproductive age who were undergoing surgical reversal of sterilization from August 1, 1993, through August 1, 1995. INTERVENTION(S): Microsurgical sterilization reversal by minilaparotomy was performed as an inpatient (group 1, 47 patients) or as an outpatient (group 2, 23 patients). MAIN OUTCOME MEASURE(S): Cost, complication rate, pregnancy rate. RESULT(S): The procedure cost more for inpatients ($3,116) than for outpatients (!,456). Pregnancy rates were similar (56% in group 1 vs. 75% in group 2). There was only one complication in the series. CONCLUSION(S): Outpatient microsurgical sterilization reversal performed by minilaparotomy is as safe and effective as the inpatient procedure and is less expensive.

Adult↗

PubMed1995

Symptomatic outcome 1 year after laparoscopic and minilaparotomy cholecystectomy: a randomized trial.

In a randomized controlled trial, 299 patients were sent a symptoms questionnaire 1 year after laparoscopic (n = 151) or minilaparotomy (n = 148) cholecystectomy for symptomatic cholelithiasis. The response rate to the questionnaire from contactable patients was 86 per cent. In both groups, at least 90 per cent of patients reported that their symptoms were improved, and at least 93 per cent rated the success of their operation as 'excellent', 'good', or 'fair'. However, over half the patients reported abdominal pain, a quarter reported flatulence, and a quarter dyspepsia. The only difference between treatment groups was that a higher proportion of patients who underwent minilaparotomy reported heartburn (35 per cent versus 19 per cent, P = 0.005). Patients who reported a 'poor' outcome were more likely to have suffered a postoperative complication, had lower quality of life scores, and higher anxiety and depression scores. Both laparoscopic and minilaparotomy cholecystectomy result in symptomatic benefit in at least 90 per cent of patients with symptomatic cholelithiasis.

Abdominal Pain↗

PubMed1978

Experience with minilaparotomy in the Philippines.

This paper presents the socio-demographic characteristics, medical histories, and clinical data on 651 women sterilized by interval minilaparotomy procedures in Manila, Philippines. About two thirds of the procedures were performed with local anesthesia; the Pomeroy technique was used for tubal ligation. In 2.8% of the patients, salpingectomy or fimbriectomy was performed on one side because of surgical difficulties and complications. Surgical difficulties were encountered in 19.8% of the procedures; adhesions (4.3%) and bowel interference (4.0%) were the most frequent causes of surgical difficulty. Complications occurred during surgery in 1.7% of the procedures. Early postoperative complications were noted in 9.1% of the cases. None of the patients required readmission to the hospital. While 612 women were followed up at 6 months, 299 were followed up at 12 months. One women (0.2%) became pregnant after sterilization; at repeat minilaparotomy, ligation of the left round ligament rather than the tube was observed. Pelvic surgery, other than pregnancy-related surgery, during the year following sterilization was reported for one patient who underwent exploratory laparotomy with appendectomy and oophorocystectomy. Menstrual pattern changes were minimal. The results of this study suggest that tubal ligation via minilaparotomy is practical, safe, and effective.

Adult↗