pelvic minilaparotomy

pelvic minilaparotomy

[min′ēlap′ərot′əmē]

a surgical operation in which the lower abdomen is entered through a small suprapubic incision. It is performed most often for tubal sterilization but also for diagnosis and treatment of ectopic pregnancy, ovarian cyst, endometriosis, and infertility. It may be performed as an alternative to laparoscopy, often on an outpatient basis. The patient is placed in the supine position, and the abdomen is prepared with antiseptic solution and covered with sterile drapes. An incision a few centimeters long is made, usually transversely, in the suprapubic fold of skin in the midline and is then carried down through the fat and fascia, between the rectus abdominis muscles, and into the peritoneal cavity. Bleeding is ligated, and a small self-retaining retractor is placed in the incision. A laparoscope may be used for visualization. The sterilization or other procedure is performed. After hemostasis is ensured, each tube is replaced in its anatomic position, and the incision is closed in layers. Because incisional pain in the postoperative period may mask the pain of intraperitoneal bleeding, vital signs are monitored frequently. Tachycardia and hypotension not alleviated by analgesia may be signs of hemorrhage or injury to the bowel. Before discharge, outpatients are carefully instructed in postoperative danger signs and proper care of the incision at home. Arrangements are made for follow-up examination. Often minilaparotomy may be performed faster and less expensively than laparoscopy. Though small, the minilaparotomy incision is considerably larger than is the usual laparoscopy incision. It is therefore less pleasing cosmetically, as well as more painful in the postoperative period. Compare laparoscopy.