Laparoscopic conservative removal of ovarian dermoid cysts

A Modified Technique to Reduce Spillage and Operative Time: Laparoscopic Ovarian Dermoid Cyst Enucleation ‘in a Bag’

“…In fact the mean operative time in our experience (64 min) is similar to that reported by Volz et al [10], who used a similar technique, and by Yuen and Rogers [20] (60 min) and Morgante et al [58] (57 min) for open surgery and by Pardi et al [42] for laparoscopy-assisted vaginal removal, but it was lower than what was reported by other authors for laparotomy [18,21,22] or laparoscopy (table 2), [8,9,12,18,19,20,21,22,26,27,29,33,34,36,37,39,40]. Our mean surgical time is also lower than that reported by Ferrari et al [38] or Wang et al [44] for the direct vaginal approach (81 and 78 min, respectively).…”

“…In recent years dermoid cysts have increasingly been removed by laparoscopy, and with this technique spillage has been reported in 54% of cases, ranging from 0 to 100% (table 1) [8,9,12,13,16,17,18,19,20,21,22,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41]. In order to reduce the risk of spillage during laparoscopy, some authors propose to remove dermoid cysts via culdotomy through an incision on the posterior vaginal fornix [26,35,42,43,44], but with this technique Teng et al [31] reported 6 cases of spillage from 14 cysts (43%); Reich et al [26] reported 9 cases of spillage in 25 cysts removed vaginally (36%), and in the experience of Nezhat et al [35] spillage occurred in 4 of 9 cysts (44%).…”

“…In the present study, we inserted the whole ovary into an endobag at the beginning of the surgical procedure; we always used hydrodissection to enucleate the cyst into the bag in order to avoid cyst rupture [8] and then we used the same endobag to remove the cyst from the abdominal cavity. In this way we reduced the risk of intraperitoneal spillage.…”

“…The advantages offered by laparoscopic treatment of ovarian cysts when compared to the traditional laparotomic approach are well defined [6,7], but the surgical management of ovarian teratomas is still controversial, and many surgeons still approach dermoid cysts laparotomically, due to the high risk of intraperitoneal cyst rupture and the related risk of chemical peritonitis or spread of any neoplastic cells. However, hydrodissection of the cyst wall [8] and the use of an endobag to remove the cyst from the abdomen [9] seem to be effective in decreasing the chance of intraoperative spillage during laparoscopic surgery. Volz et al [10] have recently used an endobag to place one or both adnexa in which laparoscopic cystectomy was then performed.…”

Adolescent ovarian tumours: a gynecologist's dilemma

“…However, recent literature for adult population suggests that laparoscopic excision is a safe procedure particularly when an endo-bag is used to remove the tumours from the abdomen. [14][15][16] There appears to be no increase in recurrence rate as compared with laparotomy. This surgical approach depends upon the laparoscopic skills of the particular surgeon.…”