An easy new approach to the laparoscopic treatment of large adnexal cysts

Abstract

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.

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“…In fact there is a growing body of evidence that there is no statistical difference in survival rates between patients undergoing a laparoscopy versus laparotomy in women with apparent early ovarian cancer or borderline tumors [4][5][6]. And given the advantages of laparoscopy in terms of faster recovery, less bleeding and reduced post-operative pain, this approach is proving to be superior to the traditional laparotomy in addressing this pathology [4].…”

“…Other authors drained the cystic mass laparoscopically inside the abdomen prior to removing it either laparoscopically through one enlarged port,a minilaparotomy or culdotomy, followed by profuse irrigation of the abdominal cavity [9][10]. Lee LC et al used a technique where they drained the mass through an open laparoscopy technique and then removed the ovarian mass extra corporeally [6]. While those techniques helped decompress the large cysts, they didn't seem to adequately prevent spillage of the masses into the abdomen.…”

Management of Large Ovarian Neoplasms in Pediatric and Adolescent Females

“…For tumors where the risk of malignancy is likely to be low but uncertain, many have advocated a hybrid minimally invasive approach, which may decrease the risk of intraperitoneal spillage of cyst contents. 39,40 Multiple hybrid approaches have been described in the literature. Yi 41 describes the laparoscopic assisted extracorporeal cystectomy (at the umbilicus with a multichannel port).…”

Single incision laparoscopic surgery for a large endometriotic cyst

“…[6789] Yet few reports have published on the SPLS approach in treating large ovarian cysts. [101112] The restricted intraabdominal working space in large ovarian cysts poses a technical challenge. Moreover, difficult convergence of operating instruments and competition for operating space outside the abdomen during the SPLS makes the procedure demanding, especially when one uses conventional instruments.…”