Morcellation Not Required: Mini-Laparotomy Does Not Alter Same-Day Discharge Plan

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Study Objective The study objective was to evaluate whether the need for mini-laparotomy (ML) for intact specimen extraction adversely impacted the feasibility or safety of same-day discharge (SDD) in patients undergoing minimally invasive surgery (MIS) for gynecologic malignancies. Design We performed a retrospective, matched, case-control study in patients undergoing MIS for gynecologic malignancy from January 2013 through December 2019. Setting Single institution. Patients or Participants Patients underwent traditional laparoscopy or robotic assisted laparoscopy and were planned for SDD. Interventions Patients requiring ML for specimen extraction were identified and matched to randomly selected patients not requiring ML (2:1, controls:cases). Clinical demographics, peri-operative outcomes and post-operative contact within 30 days were collected. Standard statistical analyses were performed to evaluate the data. Measurements and Main Results A total of 891 patients were identified. Fifty-two patients required ML for specimen extraction. From the remainder, 104 patients were selected as controls. There was no difference in age (61 vs. 63 years p=0.42) or BMI (32 vs. 30 p=0.29) between the cases and controls. SDD rate was 79% (ML) vs. 83% (control) (p=0.67). There was no difference in mean pain scores (2.3 vs. 2.2 p=0.78), length of stay (LOS) (0 days for both) (p=0.67), 30-day readmission rate (7% vs. 3%) (p=0.17), ED/Urgent care visit (21% vs. 14%) (p=0.28) or any patient contact (36% vs. 37%) (p=0.97), between the groups. Specimen weight was higher for ML (485g vs 135g, p Conclusion Mini-laparotomy for specimen extraction does not affect SDD rates after MIS. It is a safe and feasible strategy for patients with no apparent increase in complication rate or unscheduled patient contact.