Introduction/Background*Abdominal gynecological surgeries are conducted using three different basic incision types including midline vertical incisions, suprapubic transverse incisions (i.e. Pfannenstiel, Maylard, and Cherney), and infra/supraumbilical incisions. Choosing the type of incision in gynecological malignancies can be quite challenging and depends on a variety of factors including patient-oriented factors and surgeon preference. Each type of incision has its own risks and benefits compared to its counterparts. This presses for further assessment and comparison of the data published prior to this date.

Methodology A systematic literature search was conducted on the CENTRAL, MEDLINE and EMBASE databases using the following keywords individually and in combination: ‘midline incision’, ‘transverse incisions’, ‘Pfannenstiel’, ‘Maylard’, ‘Cherney’, ‘gynecologic cancers’, ‘ovarian cancer’, ‘cervical cancer’, ‘vaginal neoplasms’, and ‘uterine cancer’. The studies included were the ones outlining or comparing between surgical incisions’ outcomes. All review articles, editorials, video articles, and abstracts were excluded.

Result(s)*The preliminary literature search reported 232 articles, after extensive screening it was filtered down to 11 articles that were fully compliant with the eligibility criteria. Throughout the literature, the ‘midline incision’ was reported 10 times while a single study compared ‘paramedian incision’ with different transverse incisions.

Conclusion*The dominance of the vertical midline incisions over transverse incisions is in constant question. Some texts remain doubtful of the applicability of the transverse incision as a valid alternative. Other articles promote the equivalence of the transverse approach to the midline regarding access to anatomical spaces, with cosmetic superiority and lowered relative risks of clinical outcomes if utilized appropriately.