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The objective of this study was to evaluate the safety and potential advantages of laparoscopic approach for management of ovarian dermoid cysts and challenge the potential fear of spillage of contents of dermoid cyst during laparoscopic surgery. Out of 384 operative laparoscopies conducted at patients underwent laparoscopic removal of dermoid cysts. We employed the three-puncture technique: a 10-mm umbilical trocar for the telescope and two auxiliary 5-mm punctures for operative intervention. Thirty-one dermoid cysts with a mean diameter of 7.5 cm were removed successfully in 26 patients. The operative techniques employed were ovarian cystectomy for 28 cysts, salpingo-oophorectomy for three cysts, and one case had salpingo-oophorectomy together with laparoscopy-assisted vaginal hysterectomy (LAVH). In one case, we performed concomitant hysteroscopic excision of complete uterine septum. Fourteen cysts were removed through enucleation and removal through the trocar sleeve. Ten cases were treated via enucleation and removal within impermeable endobag. Seven cases were managed by removal of cysts via posterior colpotomy; one was managed during LAVH. We encountered 14 spillages during the procedures: in ten cases (71%) of trocar removal without the use of endobag, in one case (10%) of removal within an impermeable endobag, and in three cases (42%) of colpotomy removal. After a review of 14 studies in the literature, added to our study, we found only 0.2% incidence of chemical peritonitis following laparoscopic removal of dermoid cysts. Laparoscopic approach allows proper exposure of the cul-de-sac and forceful jet lavage aspiration, ensuring pelvic clean out from any microscopic material of the dermoid cyst. Such a situation may not be available during open laparotomy.

The carcinogenic effect of NS3P is probably exerted at an early stage of HCC possibly through a pathway involving c-erbB2 and p21(waf) alterations. In contrast, p53, p21ras and mdm2 alterations are late events in hepatocarcinogenesis and are usually associated with an aggressive phenotype.

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