Laparoscopic Management of the Adnexal Mass

Abstract

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.

Laparoscopic Treatment of Ovarian Cysts in Adolescents and Young Adults

“…7,8 Operative laparoscopy in treating an ovarian mass provides advantages such as minimal tissue trauma, less blood loss, less perioperative discomfort, decreased hospitalization, and reduced overall cost of care. 12,13 Complication rates between laparoscopy and laparotomy are comparable. 14 Another advantage of the laparoscopic approach is the post-operative cosmetic result, which is especially important for young girls.…”

“…Tumor markers in combination with the imaging assessment, such as Doppler sonography, computed tomography , or magnetic resonance imaging scan can help to determine the nature of ovarian cysts before management plan is decided. 6,13 When the cyst is unilocular with a smooth surface and thin wall, malignancy risk is very low. 22 In young girls, this preoperative diagnostic tests and careful patient selection should be performed so that ovarianpreserving management can be performed when feasible.…”

The impact on ovarian reserve after laparoscopic ovarian cystectomy versus three-stage management in patients with endometriomas: a prospective randomized study

“…Operative laparoscopy compared with laparotomy has been established as the gold standard surgical approach in the treatment of endometriomas in terms of reduced postoperative pain, analgesic requirement, hospitalization, and lower incidence of de novo adhesion formation (4).…”

The experience of our clinic in clinical approach to the adnexal masses and pathological findings

“…Adneksiyal kitlelere cerrahi yaklaşımda önceleri laparotomi yeğlenirken, son yıllarda benign adneksiyal kitlelerde bazı avantajları nedeniyle (operasyon sonrası sürenin kısa olması, daha az ağrı, daha az adhezyon oluşumu, yara iyileşme süresinde kısalma, hastanede kalma süresinde azalma ve daha az maliyet) LS ilk seçenek olarak düşünülmektedir (4,8) . Bununla birlikte, LS'nin uzman deneyimi gerektirdiği ve bazı komplikasyonların (açık cerrahide olduğu gibi veya farklı olarak periton dışına gaz kaçışı ve gaz embolisi gibi) gelişebileceği bilinmektedir (9) .…”