We describe a technique for laparoscopically assisted extracorporeal cystectomy or adnexectomy of large adnexal cysts without spillage of the cyst contents. At open laparoscopy, a suction tube decompressed the adnexal cyst from the 2-cm umbilical incision and the puncture hole was closed by the purse string tie, which was followed by extra-corporeal excision of the cyst. With this method, we prevent cyst spillage in three ways. Firstly, the cyst is aspirated extracorporeally. Secondly, when the cyst is totally collapsed, the puncture point is closed with a 1-o Vicryl purse suture and pulled to the umbilicus. Thirdly, as soon as a part of the mass is delivered from the abdomen, it is lined with moist gauze. This method provides excellent visualization and control of the penetration site during aspiration, and minimizes the chances of the cyst contents leaking into the peritoneal cavity. This method was successfully used with 12 patients, including four cystadenomas, one serous cystadenoma, three dermoid cysts (with one pregnant woman who successfully spontaneously delivered a normal baby at term), two low malignant potential ovarian tumors and one grade I endometrioid adenocarcinoma. The cancer patient has shown no recurrence after a follow-up of three years.
The role of laparoscopic surgery in the management of gynecological cancers continues to expand. For early-stage cervical cancer, laparoscopically assisted radical vaginal hysterectomy is feasible, and radical vaginal trachelectomy with laparoscopic pelvic lymphadenectomy has emerged as a safe option for women who desire fertility preservation. In the treatment of early-stage endometrial cancer, the surgical staging of laparoscopic hysterectomy, peritoneal washings and pelvic lymph node dissection is effective and safe when compared with the same surgery performed via laparotomy. In ovarian malignancies, laparoscopic surgery has been incorporated to manage early-stage cancers.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.