Surgical treatment of ovarian dermoid cysts: a comparison between laparoscopic and vaginal removal

Ferrari, María Rosa; Mezzopane, R.; Bulfoni, A; Grijuela, Barbara; Carminati, Roberto; Ferrazzi, E.; Pardi, Giorgio

doi:10.1016/s0301-2115(02)00510-9

Cited by 33 publications

(24 citation statements)

References 8 publications

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“…Moreover, a study reported that vaginal removal of cysts resulted in equal operation time, reduced spillage and faster recovery compared with laparoscopy. 13 When performed successfully, the procedure compares favorably with laparoscopic surgery in terms of its invasiveness. 9 Therefore, these advantages make this procedure a valuable addition to a surgeon's repertoire.…”

Section: Discussionmentioning

confidence: 99%

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Transvaginal natural orifice transluminal endoscopic surgery for adnexal masses

Yang

Hur

et al. 2013

J of Obstet and Gynaecol

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Aim: Natural orifice transluminal endoscopic surgery (NOTES) is currently a very important topic for surgeons. This study aimed to describe the initial clinical experience of transvaginal NOTES for adnexal masses and investigate its feasibility and surgical outcome. Methods: We performed transvaginal NOTES in seven patients with adnexal masses through a 2-cm incision in the posterior vaginal fornix. A transvaginal NOTES system comprising a wound protractor and a surgical glove with sheaths was used. Resection was performed according to the method of standard laparoscopic adnexal surgery. The adnexal mass was removed via the incision of the posterior vaginal fornix after complete resection. Results: Since June 2011, seven patients have undergone transvaginal NOTES for adnexal masses. All cases were completed successfully without conversion to standard laparoscopic approach. The median age of the patients was 48 years (range, 36-60) and the median body mass index was 23.6 (range, 20.4-25.3). The median tumor size was 6 cm (range, 3.7-6.7). The median operative time was 45 min (range, 40-80). The estimated blood loss was minimal (range, 5-300 mL). The median postoperative hospital stay was 2 days (range, 1-3). No postoperative complications were observed at follow-up. All the patients were very satisfied with the cosmetic result. Conclusion:The findings show transvaginal NOTES with our method to be a feasible, safe and effective surgical technique that results in excellent cosmesis. It may be an alternative technique for the treatment of properly selected female patients with adnexal masses. More experience and instrumental improvement suitable for transvaginal NOTES are needed.

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Section: Discussionmentioning

confidence: 99%

“…After at least 3 months, patients were evaluated concerning cosmetic satisfaction, dyspareunia and any possible negative experiences. The mean follow-up duration was 8 months (range, [3][4][5][6][7][8][9][10][11][12][13].…”

Section: Patientsmentioning

confidence: 99%

Transvaginal natural orifice transluminal endoscopic surgery for adnexal masses

Yang

Hur

et al. 2013

J of Obstet and Gynaecol

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“…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%).…”

Section: Discussionmentioning

confidence: 99%

“…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 a retrospective study, Ferrari et al [38] proposed a direct vaginal approach without laparoscopic assistance for surgical treatment of ovarian dermoid cysts. In 33 cystectomies, 1 case of spillage occurred (3%), but 2 cases of febrile morbidity after surgery were observed and the mean operative time was 81.3 min (range 40–180).…”

Section: Discussionmentioning

confidence: 99%

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

Campo

2010

Gynecol Obstet Invest

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Background: To describe the outcomes of a modified technique for conservative laparoscopic enucleation of ovarian dermoid cyst, placing the ovary in an endobag during enucleation to prevent intraperitoneal spillage. Methods: Laparoscopic dermoid cyst enucleation was performed in 35 cases of premenopausal patients placing the ovary in an endobag at the beginning of the procedure and removing the cyst from the abdominal cavity by the same endobag. Results: Dermoid cysts with a mean diameter of 6.3 ± 2.7 cm were enucleated and removed laparoscopically ‘in a bag’ without intra- or postoperative complications. Cyst rupture occurred in 10 cases (28.5%), but evident peritoneal contamination occurred in only 2 (5.7%; 95% confidence interval: 0.7–19.2%), because in 8 patients spillage was contained by the surrounding bag. The mean operative time was 64.6 ± 27 min. No signs or symptoms of peritonitis were observed. The mean postoperative hospitalization was 1.6 ± 1.4 days. Among the 12 infertile patients, 7 spontaneous pregnancies (58%) occurred. Conclusions: Laparoscopic conservative excision of dermoid cysts placing the ovary in an endobag at the beginning of surgery and removing the cyst by the same bag is a safe and effective approach to reduce intraperitoneal spillage and operative time.

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“…An experimental study has proved that saline lavage decreases inflammation and adhesion formation to control levels [4] 5. Vaginal removal of dermoid cyst also decreases spillage as compared to laparoscopic retrieval [12] There is very limited information in published literature on the management of chemical peritonitis following rupture of dermoid cyst contents. The use of systemic anti-inflammatory agents has been described [13].…”

Section: Discussionmentioning

confidence: 99%