***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To compare the surgical management and follow-up of patients with endometriomas managed by endoscopic surgery versus laparotomy  using a retrospective case control format . DESIGN Endoscopic oophorocystectomies were performed on 36 patients . Chart review of laparotomy oophorocystectomies from 21 patients was conducted . Six-week and 12-month follow-up for evaluation of symptoms , evidence of recurrence , and fertility was available on all subjects . RESULTS In the endoscopy group , 39 patients had screening laparoscopy for possible endoscopic surgery .  Three of this group required laparotomy and 36 patients underwent endoscopic surgery . Chart review identified 21 patients who had undergone primary laparotomy for endometriomas . Patient groups were matched for age , severity of disease , presence of other infertility factors , and absence of perioperative medical suppression . Outcome parameters for each group were : operating time -- endoscopy  2.8 hours ( + /- 1.2 ) , laparotomy 3.1 hours ( + /- 1.8 ) ; estimated blood loss --  endoscopy 40 cc ( + /- 45 ) ; laparotomy , 240 cc ( + /- 107 ) ; recovery time --  endoscopy , 6.2 days ( + /- 2.5 ) , laparotomy 30 days ( + /- 6.8 ) ; endometrioma recurrence rate --  endoscopy 11.1 % , laparotomy 19 % ; and pregnancy rate -- endoscopy 42.8 % , laparotomy 46.6 % . CONCLUSION A high percentage of patients with endometriomas associated with advanced endometriosis can be managed effectively by endoscopic surgery OBJECTIVE To evaluate the efficacy of  laparoscopic ovarian cystectomy  and to compare the surgical course , post-surgical course and particularly post-surgical pain of the laparoscopic and laparotomic methods . STUDY DESIGN We conducted a surgical study on dermoid cysts at the Gynecology Department of Siena University between 1 January 1992 and 31 December 1996 . The selected cases were r and omized into two groups based on surgical approach : via laparotomy ( n=22 ) or laparoscopy ( n=22 ) . Surgical times , estimated blood loss , post-surgical pain , time in hospital , speed of recovery and complications were compared . RESULTS Mean blood loss was significantly less for laparoscopy ( 58.64+/-30.17 ml versus 103.84+/-38.45 ml , P<0.05 ) . Mean hospitalization was 6.32+/-1.09 days for laparotomy and 3.18+/-0.39 days for laparoscopy ( P<0.05 ) . Post-surgical pain was significantly less in laparoscopy patients ( P<0.05 ) . The laparoscopic technique had fewer post-surgical complications . CONCLUSIONS The laparoscopic approach had many advantages . Laparoscopy should be the elective treatment for women with dermoid cysts , because it has many advantages for the patient and lower costs for the national health system OBJECTIVES Our purpose was to evaluate the efficacy of laparoscopic ovarian dermoid cystectomy  and to compare the operative course , postoperative course , and complications between the laparoscopy and the laparotomy techniques . STUDY DESIGN The safety and efficacy of  laparoscopic ovarian dermoid cystectomy were evaluated in 40 women . Twenty-nine of 40 patients underwent laparoscopic excision of a solitary dermoid cyst without any additional procedure . The operative course , the postoperative course , and complications among these 29 women were compared with those of 26 other women who underwent a similar procedure by laparotomy . RESULTS Spillage of the cyst 's content did not lead to any complication . The operating time in the laparoscopy group was 73.5 + /- 4.7 minutes and in the laparotomy group it was 41.4 + /- 2.9 minutes . The duration of hospitalization was significantly shorter in the laparoscopy group ( 0.7 + /- 0.2 days ) than in the laparotomy group ( 3.8 + /- 0.1 days ) . CONCLUSIONS Although ovarian dermoid cystectomy by laparoscopy is associated with a longer operating time than by laparotomy , the duration of hospitalization is shorter and recovery is faster . Spillage of the contents of the dermoid cyst does not lead to any complication ; perhaps this is due to the liberal irrigation of the peritoneal cavity STUDY OBJECTIVE To compare the outcome of laparoscopic treatment of adnexal masses with treatment by laparotomy . The procedures , their duration , and associated complications also were evaluated . DESIGN Women were r and omized to undergo either procedure based on the ward to which they were admitted . SETTING A university teaching hospital . PATIENTS The 192 patients were admitted with a preoperative diagnosis of adnexal mass . INTERVENTIONS Surgical procedures were cystectomy , salpingectomy , oophorectomy , and unilateral or bilateral salpingo-oophorectomy . Organ-preserving techniques were used wherever possible . All tissue specimens were examined histologically . MEASUREMENTS AND MAIN RESULTS The mean duration of surgery was statistically not significantly different between the groups , 96.8 minutes for minimally invasive surgery , and 116 minutes for laparotomy . Organ preservation did reach statistical significance at 65.7 % and 17.2 % respectively ( p < 0.001 ) . Postoperative morbidity was statistically lower in patients undergoing minimally invasive procedures . Preoperative tumor marker levels did not correlate well with postoperative histology . One woman in the laparotomy group had histologically proved ovarian cancer . Minimally invasive surgery was converted to laparotomy in three patients in whom malignancy was suspected at the start of operation . CONCLUSIONS Laparoscopic management of adnexal masses has definite advantages over laparotomy , for example , lower postoperative morbidity . In addition , intraoperative endoscopic diagnosis is highly accurate , and the frequency of unnecessary procedures is lower OBJECTIVE To analyze clinical results and financial costs of  salpingo-oophorectomy performed by laparoscopy versus laparotomy . STUDY DESIGN Comparison of laparoscopic salpingo-oophorectomy with procedures performed by laparotomy . SETTING St. Vincent 's Hospital and Fallon Clinic in Worcester , Massachusetts . PATIENTS Twenty women in both groups . INTERVENTIONS Salpingo-oophorectomies performed by laparoscopy and laparotomy . MEASUREMENTS AND MAIN RESULTS Women undergoing laparotomy had a 25 % rate of postoperative complications compared with 0 % of those having laparoscopy . The duration of the procedures and hospital charges were similar for both groups . Length of hospital stay and time to return to work were significantly less after laparoscopy than laparotomy . CONCLUSIONS Laparoscopic salpingo-oophorectomy was associated with significantly fewer complications than the operations performed by laparotomy . Although women in the laparoscopy group had a shorter hospital stay , their higher charges were attributed to costly disposable instruments . Patients benefit from early return to work and other activities after laparoscopy OBJECTIVE Our purpose was to compare the newer technique of laparoscopic adnexal excision with conventional laparotomy . DESIGN With the same entry criteria , a retrospective , consecutive series of 26 women who underwent adnexectomy by laparotomy was compared with a later prospect i ve consecutive series of 64 women who had laparoscopic adnexectomy in a university referral practice . The two groups were similar in all characteristics examined . The ages of the women ranged from 18 to 70 years , but only two women were postmenopausal . Pelvic pain with or without an ovarian cystic mass was the surgical indication in 91 % to 92 % of the women . Seven women had a persistent adnexal cystic mass and one woman had a unilateral and rogen-secreting ovary . Bipolar coagulation was the laparoscopic method used . RESULTS Median operating time ( 88 vs 107 minutes ) , blood loss ( 72 vs 222 ml ) , days in the hospital ( 1 day vs 3 days ) , total costs ( $ 4573 vs $ 6044 ) , and recovery time ( 1 week vs 4 weeks ) were significantly less with laparoscopic adnexectomy . There were no differences between the two techniques in major complications ( one in each group ) , blood transfusions , adhesion formation , or the proportion of women noting improvement of pain symptoms . CONCLUSION In this preliminary assessment of laparoscopic adnexectomy , this surgical procedure offers significant advantages to laparotomy in selected patients when performed by a laparoscopist experienced in advanced techniques The aim of our study was to compare laparoscopy with laparotomy for the removal of ovarian dermoid cysts . Thirty-eight women with benign ovarian dermoid cyst were allocated for either laparoscopy ( 18 patients ) or laparotomy ( 20 patients ) . The two groups were compared for operative and hospitalization times and postoperative course . Operating time was longer ( 93.6 + /- 23.8 min ) and hospitalization time significantly shorter ( 22.4 + /- 6.6 h ) in the laparoscopy group . No complications were reported in either group . We conclude that operative laparoscopy is a safe procedure for the removal of dermoid ovarian cysts and is as effective as laparotomy OBJECTIVES The aim of the study is to specify the place , modalities and results of operative laparoscopy when adnexectomy is indicated in a patient presenting with an adnexal mass . STUDY DESIGN A retrospective analysis of the 186 patients who underwent adnexectomy for an adnexal mass between January 1 , 1989 and December 31 , 1994 . RESULTS The operation took place via laparotomy in 34.9 % of cases ( 65 patients ) and by laparoscopic surgery in 65.1 % of cases ( 121 patients ) . All the patients presenting a malignant ovarian lesion ( 15 cases ) were operated by laparotomy . For these patients the laparotomy was decided from the outset in 7 cases and there was a conversion to laparotomy decided during the diagnostic phase of laparoscopy in 8 cases . The preoperative workup ( clinical examination , study of past history , trans vaginal ultrasonography , doppler , tumoral markers etc . ) together with the diagnostic phase of laparoscopy provide 100 % sensitivity , a positive predictive value of 50 % and a negative predictive value of 100 % for diagnosis of malignancy . CONCLUSION These results demonstrate that provided a strict selection system is used , it is possible to carry out adnexectomy using laparoscopic surgery in 70.8 % of cases ( 121/171 ) for patients with benign adnexal mass OBJECTIVE Our purpose was to compare the results of laparoscopy with laparotomy in the management of ovarian masses not suspected to be malignant . STUDY DESIGN In a prospect i ve r and omized study 102 patients requiring surgical management of ovarian masses were r and omly assigned to  laparoscopy  ( 52 ) or laparotomy ( 50 ) in a teaching hospital from July 1994 to September 1995 . Inclusion criteria was tumor not suspected to be malignant with a diameter of < or = 10 cm as measured by ultrasonography . All operations were performed by trainees under the supervision of an experienced surgeon . Statistical analysis included t tests and chi2 tests . RESULTS There were no differences in demographic characteristics between the two groups nor any difference in the size of ovarian masses , adnexal adhesion score , or frequency of bilateral disease . All the ovarian masses were benign . Endometriotic cysts and dermoid cysts were the most common disorder in the two groups . Cystectomy was performed in > 70 % of cases in each group . Operating time was not increased with the laparoscopic approach , and the frequency of inadvertent rupture of the ovarian masses was just as high as in laparotomy . The laparoscopic approach was associated with a significant reduction in operative morbidity ( odds ratio 0.34 , 95 % confidence interval 0.13 to 0.88 ) , postoperative pain and analgesic requirement , hospital stay , and recovery period . Patients in general were satisfied with the operation , but significantly more patients were satisfied with the laparoscopy scar . CONCLUSION Operative laparoscopy should replace laparotomy in the management of benign ovarian masses Objective To compare laparoscopy and laparotomy in the management of benign adnexal cysts , with particular attention to postoperative convalescence . Methods Forty premenopausal , nonpregnant women , 18–40 years of age and without acute pelvic symptoms , were scheduled to undergo surgical management of anechoic , unilateral , unilocular , persistent adnexal cysts from January 1993 through June 1994 at the Department of Obstetrics and Gynecology of the University of Cagliari , Cagliari , Italy . After ultrasonographic examination , followed by the completion of 6 months ' expectant management with repeat ultrasonographic evaluations , subjects were r and omized to undergo operative laparoscopy ( n = 20 ) or laparotomy ( n = 20 ) . The patients 
    Output:
    
Laparoscopy is associated with a reduction in the following : febrile morbidity , urinary tract infection , postoperative complications , postoperative pain , days in hospital , and total cost .