Pelviscopic Treatment of Ovarian Cysts in Premenopausal Women

Abstract

Between 1984 and 1989,773 patients ≤ 45 years of age, presenting with a total of 809 ovarian cysts, underwent pelviscopy at the Department of Obstetrics and Gynecology of Kiel University. In 36 cases, cysts were bilateral. 678 cysts (84%) were treated by pelviscopy alone. Organ-preserving treatment was performed in 83%, oophorectomy or adnexectomy in only 17% of cases. Two stage la ovarian carcinomas (0.26% of all cysts) were operated on by pelviscopy before laparotomy. Sonography is particularly important in determining whether a pelviscopic approach is appropriate. Pelviscopic procedures are unacceptable in multilocular cysts measuring ≥ 7 cm in diameter with echodense components. Special caution is required for any cyst measuring > 9 cm in diameter. The risk of opening a malignant cyst must be weighed against the advantages of pelviscopic surgery: minimal physical strain, better postoperative quality of life, and organ conservation. In doubtful cases, laparotomy is recommended.

Operative Laparoscopic Management of Adnexal Cysts: Initial Experience at the Royal Women's Hospital 1991–1994

“…It is important to undertake a thorough preoperative assessment in order to avoid the inadvertent treatment of malignant cysts by operative laparoscopy. In premenopausal women with no ultrasound features of malignancy, the probability of inadvertently treating an early malignancy (Stage l a or lb) and upstaging the lesion to an iatrogenic Stage l c is very low (12)(13)(14)(15). In a retrospective study of 773 patients treated by operative laparoscopy, only 2 Stage l a ovarian carcinomas were opened intraabdominally and transformed into Stage Ic lesions (14).…”

“…In premenopausal women with no ultrasound features of malignancy, the probability of inadvertently treating an early malignancy (Stage l a or lb) and upstaging the lesion to an iatrogenic Stage l c is very low (12)(13)(14)(15). In a retrospective study of 773 patients treated by operative laparoscopy, only 2 Stage l a ovarian carcinomas were opened intraabdominally and transformed into Stage Ic lesions (14). A prospective study of 372 premenopausal women who had adnexal cysts with benign features on vaginal ultrasound, found 2 cases (0.5%) of malignancy after laparoscopic treatments ( 1 2).…”

“…It is generally believed that cysts greater than 8-10 cm in diameter have an increased risk of being malignant (12)(13)(14) especially in postmenopausal women. Whether the benefits of a laparoscopic approach outweigh the risks in this group of patients has yet to be determined.…”

Impact of a multiparameter, ultrasound‐based triage on surgical management of adnexal masses

“…A reliable preoperative differential diagnosis between benign and malignant lesions may contribute to an improvement in the management of adnexal masses. In fact, by means of an accurate preoperative evaluation, it would be possible to schedule women with benign masses for laparoscopic treatment, with a shorter hospital stay and a lower morbidity as compared to laparotomy [1][2][3][4] , while adequate preoperative counseling and surgical approach would be carried out in cases truly at high risk of ovarian cancer.…”

Unexpected ovarian malignancy after conservative laparoscopic surgery: five case series in a half decade of experience

“…Few large series of ovarian cysts managed by laparoscopy have been published in the literature, with rates of unexpected malignancy ranging between 0.3 and 2.5% [15][16][17][18]. However, these series focussed on unexpected malignancy found intraoperatively whereas in our study, we analysed the cases of unexpected malignancy diagnosed postoperatively by final pathological report.…”