Diagnosis and management of organic ovarian cysts: indications and procedures for laparoscopy

Laparoscopic approaches to giant ovarian cysts, particularly in adolescents, have critical management concerns as follows: risk of malignancy, risk of cyst rupture, and limited working space. A 15-year-old girl presented with a giant (N25 cm) ovarian serous cyst adenoma containing 7 L of fluid. At open laparoscopy, a giant, entirely cystic, smooth mass originating from the right ovary and lying between the symphysis and the xiphoid was observed. After intraabdominal fluid aspiration, open conservative cystectomy was performed, avoiding spillage. The patient made an uneventful postoperative recovery and was discharged on the second postoperative day. To our knowledge, this is the largest ovarian cyst treated conservatively in an adolescent. Minimal access surgery, laparoscopy and open cystectomy, can be safely proposed in this group of patients. Conservative surgery should always be evaluated for preservation of ovarian function in cases of giant ovarian cysts in adolescents. Published by Elsevier Inc.Large ovarian cysts in adolescents may present as a challenge to gynecologists. The patient's age, menstrual status, the size and structure of the cyst, risk of malignancy, and symptoms are critical in choosing treatment strategies.Laparoscopy represents the gold standard approach for the treatment of ovarian cysts. In the adolescent population, laparoscopy may be difficult, particularly when the cysts' sizes extend to the umbilicus because of limited working space, risk of rupture, and perioperative problems related to cardiorespiratory function [1].Currently, many treat large ovarian cysts in adolescents by ovariectomy, whereas a few try laparoscopic cystectomy after aspiration of the cyst (blindly or under ultrasound [US] guidance). These techniques do not rule out the risk of spillage and do not allow the surgeon to inspect the peritoneal cavity and the posterior cyst wall properly, which is considered a very important precaution to take before performing a cystectomy [2].We present a case of a 15-year-old virgin girl with a giant ovarian cyst that was treated by minimal access surgery, laparoscopy and open cystectomy.

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“…Normal levels of tumor markers, especially serum CA 125 levels, support the benign characteristics of the cyst [4,5].…”

Section: Discussionmentioning

confidence: 91%

Seven-liter ovarian cyst in an adolescent treated by minimal access surgery: laparoscopy and open cystectomy

Coccia

Rizzello

Bracco

et al. 2009

Journal of Pediatric Surgery

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“…An accurate differential diagnosis avoids unnecessary surgical procedures, allowing, in young patients with EC, preservation of fertility through the use of laparoscopic surgery with ovarian conservation [22] .…”

Section: Resultsmentioning

confidence: 99%

Color Doppler Ultrasound Indices in Endometriotic Cysts

Hajialioghlo¹,

Ghatresamani²,

Nezami³

et al. 2009

American J. of Applied Sciences

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Problem statement:There have been considerable interests on using non-invasive techniques to detect endometriosis. A few studies were evaluated the Doppler ultrasound findings of endometriosis. This study aimed to characterize the grayscale and Doppler ultrasound findings of endometriosis. Approach: During present prospective study, gray scale and Doppler ultrasound findings of 37 women with final diagnosis of endometriosis were evaluated. Patients with probable diagnosis of endometriosis underwent conventional transvaginal and color Doppler assessment. After laparascopic confirmation of endometriosis, gray scale and color Doppler ultrasonographic data of patients considered for analysis. Results: Finally data of 37 subjects' data with suspected endometriosis was analyzed. Twenty nine of lesions were endometriosis, five hydrosalpinx, four paraovarian adhesion cysts and one peritoneal inclusion cyst according to laparoscopic exploration. Out of 29 endometriotic cysts, flow was detected in 58.62%. The mean of RI and PI were 0.67±0.15 (0.46-1.00) and 1.49±0.85 (0.66-3.11), respectively. Conclusion: In our experience, transvaginal sonography with color Doppler interrogation is a useful technique in the diagnosis of pathologic ovarian conditions, including cystic endometriosis.

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“…On the contrary, sensitivity of transabdominal ultrasound varies between 60–93% and the specificity between 42–95%. This discrepancy is related to the operator's experience and what criteria indicative of malignancy have been used 19 . However, the diagnostic accuracy of ultrasound is limited by the cyclic changes caused in ovulating premenopausal women.…”

Section: Preoperative Investigation Of Adnexal Massesmentioning

confidence: 99%

“…Otherwise, the woman is referred to a cancer center for further management as soon as possible. At laparotomy the staging procedure and treatment of ovarian cancer should include cytology of peritoneal washings or ascites, biopsies from adhesions and suspicious areas, total abdominal hysterectomy with bilateral oophorectomy, and infracolic omentectomy as well as selective pelvic and paraaortic lymphadenectomy 19 …”

Section: Laparoscopic Approach Of Adnexal Masses In Postmenopausal Agementioning

confidence: 99%

Laparoscopic Management of the Adnexal Mass

Pados

Tsolakidis

Bontis

2006

Annals of the New York Academy of Sciences

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In the past few years the contribution of operative laparoscopy in all fields of gynecological surgery has been revolutionary. Nowadays laparoscopic management of adnexal masses is the most frequently performed laparoscopic intervention. Laparoscopy in comparison to laparotomy has the advantages of lower morbidity, shorter length of hospital stay, decreased postoperative pain, lesser de novo adhesion formation, better cosmetic results, faster recovery, and reduced overall cost of care. However, careful preoperative evaluation is important for the appropriate and successful use of laparoscopy for removal of adnexal masses and the advantages of the laparoscopic approach should, in no way, compromise the clinical outcome in women with malignancy. Patient's age, history, findings of physical examination, and the results of serum markers in combination with the imaging assessment, such as Doppler sonography, CT, or MRI, should be considered to reach the diagnosis preoperatively. However, only pathology of the adnexal mass can provide the definitive diagnosis. The specific characteristics of the adnexal masses in childhood, adolescent, reproductive, and postmenopausal age represent the essential parameters that will determine the therapeutic strategy to be followed. Furthermore, the clinician has to determine whether an adnexal mass requires surgery or expectant management as well as to estimate the possibility of malignancy.

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Diagnosis and management of organic ovarian cysts: indications and procedures for laparoscopy

Cited by 23 publications

References 62 publications

Seven-liter ovarian cyst in an adolescent treated by minimal access surgery: laparoscopy and open cystectomy

Seven-liter ovarian cyst in an adolescent treated by minimal access surgery: laparoscopy and open cystectomy

Color Doppler Ultrasound Indices in Endometriotic Cysts

Laparoscopic Management of the Adnexal Mass

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