Laparoscopic Surgery for Large Benign Ovarian Cysts: Experience in a Tertiary Care Hospital in Bangladesh

Abstract

Background: Laparoscopic surgery is the method of choice for treating women with benign adnexal masses. The aim of the current study is to assess the feasibility and surgical outcome of laparoscopic surgery among women with large benign ovarian cysts with a minimum risk of converting the operation to a laparotomy. Materials and methods: Symptomatic women (abdominal pain or mass) with a clinical or ultrasound diagnosis of an adnexal mass were offered a detailed transvaginal ultrasound scan in order to assess the feasibility of laparoscopic cystectomy=oophorectomy. The following patient information was abstracted: age, menopausal status, body-mass index, preoperative imaging studies, cyst dimensions, preoperative CA-125, date of surgery, surgical procedures, estimated amount of blood loss (EBL), conversion to laparotomy and its causes, operative time, operative and postoperative complications, length of hospital stay, and long-term follow-up. Results: All patients had transvaginal and transabdominal ultrasounds and 18 patients had computed tomography of the abdomen and pelvis. The mean and range of maximum diameter of the ovarian cysts were 16 (10-22 cm). Twenty-seven (27) cysts (51.5%) were unilocular and 16 (27.3%) had one to five septa. Fourteen (14) cysts (21.2%) had an echogenic area thought to be consistent with dermoids. None of the patients had ascites, omental cake, or lymphadenopathy in preoperative imaging studies. Fifty-two (84.8%) patients had preoperative CA-125 values within the normal range (<35 IU=mL). Five (5; 15.5%) patients had elevated 43, 53, 57, and 67 IU=mL, respectively). None of the patients had operative or postoperative complications or had to be converted to laparotomy. The mean (range) operative time, EBL, and hospital stay were 32 (20-45 minutes), 27 (5-55 mL), 8 (4-12 hours), respectively. The pathologic findings included endometriosis (n ¼ 14), dermoid (n ¼ 13), para-ovarian cyst (n ¼ 9), serous cyst adenoma (n ¼ 9), benign epithelial-lined cyst (simple cyst) (n ¼ 5), mucinous cystadenoma (n ¼ 4), borderline ovarian tumors (n ¼ 2), and peritoneal pseudocyst (n ¼ 1) Conclusions: Laparoscopic surgery among women with large benign ovarian cyst is feasible with a minimum risk of converting the operation to a laparotomy. ( J GYNECOL SURG 27:83)