Laparoscopy Compared With Laparoscopically Guided Minilaparotomy for Large Adnexal Masses

Abstract

I.

Risk for Malignant and Borderline Ovarian Neoplasms Following Basic Preoperative Evaluation by Ultrasonography, Ca125 Level and Age

“…The vast majority of adnexal masses can be safely managed laparoscopically provided that there are basic preoperative evaluation, expertise in gynecologic oncology and immediate access to frozen section diagnosis. On the other hand, accumulating scientific data support the laparoscopic approach to the large adnexal mass without any other signs of malignancy, as safe and effective treatment (Panici et al, 2007).…”

Single-port-access, hand-assisted laparoscopic surgery for benign large adnexal tumors versus single-port pure laparoscopic surgery for adnexal tumors

“…In a randomized controlled trial comparing the removal of large adnexal tumors (size, 7-18 cm) using laparoscopy and laparoscopically guided minilaparotomy, capsular rupture occurred in 87% and 29% of the patients, respectively [28]. The relative risk of intraperitoneal spillage for patients undergoing laparoscopy compared with those undergoing minilaparotomy was 5.5 (95% CI, 1.88-16.33) [28]. Adnexectomy procedures are reported to be associated with low rupture rates when performed by laparoscopy or laparotomy.…”

“…After total collapse of the adnexal tumor without spillage, the suction apparatus was removed from the tumor capsule, and the puncture site was ligated to avoid any leakage of cystic fluid. This procedure was somewhat similar to minilaparotomy procedures for large adnexal tumors [28], but SPA-HALS for large adnexal tumors could be performed through the umbilical skin incision only.…”

Leak-proof extracorporeal drainage for management of large ovarian tumors

“…Without decompression of the tumors, the space-occupying masses hamper the optimal visualization of surgical field and the mobility of instruments and make laparoscopic procedures relatively difficult technically. Meanwhile, it is also difficult to avoid unintentional tumor rupture and subsequent intra-abdominal spillage of cyst contents during laparoscopic enucleation [8]. Therefore, a safe and applicable aspiration method is required in this situation.…”