Laparoscopic Management of Benign Ovarian Cysts: Three Years Experience in Combined Military Hospital, Dhaka (original) (raw)
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Large ovarian cysts assumed to be benign treated via laparoscopy
Gynecological Surgery, 2015
The aim of this study was to assess the feasibility and outcome of laparoscopic surgery in the management of large ovarian cysts in patients treated at a university hospital. Twelve patients with large (diameter >10 cm) ovarian cysts were managed laparoscopically from November 2009 to July 2014. The cystic masses were not associated with ascites or enlarged lymph nodes on ultrasound. Serum CA-125 levels were within the normal range (35 U/ml). Preoperative evaluation included history, clinical examination, sonographic images, and serum markers. The management of these ovarian cysts included aspiration, cystectomy, or salpingo-oophorectomy, depending on the patient's age, obstetric history, and desire for future fertility. Five patients presented with abdominal pain and two with abdominal distension and discomfort. In the five patients, the cyst was an incidental finding on a routine review. The average maximum diameter of the ovarian cysts was 25 cm (range 13-41 cm). The mean duration of the operation was 87 min. The postoperative hospital stay was 1-4 days. No intraoperative complications occurred, and the hospital course of all patients was uncomplicated. In no case was laparoscopy converted to laparotomy. With proper patient selection, the size of an ovarian cyst is not necessarily a contraindication for laparoscopic surgery.
Laparoscopic Approach to Ovarian Cysts in Women over 40 Years of Age
Annals of the New York Academy of Sciences, 2006
For many years, the traditional treatment of ovarian cysts has been laparotomy. This approach is characterized, however, by elevated morbidity given that the majority of these cysts are very often benign. The main problem regarding the laparoscopic approach to the ovarian cyst is the risk of treating an ovarian cancer. As a consequence, there can be a worsening of prognosis, due to spillage at the time of laparoscopic surgery. According to the literature, the incidence of ovarian carcinoma among patients who have undergone operative laparoscopy for adnexal masses varies from 0.1% to 4.2%. 1-8 Canis et al. 6 reported 19 cases of ovarian tumors out of 819 adnexal masses in 757 patients. The 19 ovarian tumors (2.32%) were classified as (n = 7) ovarian carcinomas and low malignant potential tumors (n = 12). If we consider the incidence of these tumors in relation to age, 1.8% were found in women under 50 and 7.6% were found in women over 50 years of age. In a retrospective study, Maiman et al. 2 reported a total of 42 cases of malignancy after laparoscopic treatment of ovarian masses. However, only 12% of the physicians interviewed had used tumor markers, and only 40% had requested an intraoperative frozen section. Moreover, four of the most accepted benign characteristics of cysts, that is, diameter less than 8 cm, cystic neoplasm, unilaterality, and uniloculariety, were present in 31% of the cases. Some retrospective studies 9-13 on the problem of spillage have reported that surgical rupture of the capsule in stage I epithelial ovarian cancer has an adverse influence on survival prognosis. However, other retrospective studies have reported that surgical rupture of a malignant cyst is not a negative prognostic factor, at multivariate analysis. In fact, some authors affirm that prognosis is not influenced at all if the patient is immediately treated. 14-16 We would like to stress that the majority of ovarian cysts (87%) are benign 17 and are therefore eligible for endoscopic treatment. Following strict guidelines (echographic criteria of benignity: unilaterality, uniloculariety, absence of septa > 3 mm and intracystic vegetation, and pure borders; CA 125 levels < 35 IU/ml; benign laparoscopic appearance of cyst and the peritoneal cavity) and using cautious management, laparoscopic treatment of ovarian cysts can be reliable and safe. On the other hand, Canis et al. 6 reported on two malignant tumors that had been macroscopically suspicious and were treated as benign masses. The false negative diagnoses (1.5%) were due to inadequate sampling. Thus, Canis suggested that the
Laparoscopic Management of Benign Ovarian Masses
Journal of Nepal Medical Association
Introduction: Laparoscopic surgery is one of the most common procedures performed for benign ovarian masses. The aim of the study was to analyze all benign ovarian masses treated laparoscopically to assess safety, feasibility and outcome.Methods: A prospective study was carried out at Kathmandu Medical College Teaching Hospital, Sinamangal, Nepal. All the patients undergoing laparoscopic surgery for benign ovarian masses from 1st January 2012 to 31st December 2012 were included in the study. The pre-operative findings, intra-operative findings, operative techniques and post-operative complications were analyzed.Results: Thirty-six patients were taken for the study. Two cases were excluded since intra-operatively they were tubo-ovarian masses. The most common tumor was dermoid cyst (n=13; 38.23%) and endometriotic cyst (n=14; 41.17%). Out of 34 cases, five cases of endometriotic cyst (14.70%) were converted to laparotomy due to severe adhesions and four cases of endometriotic cyst un...
Should We Manage Large Ovarian Cysts Laparoscopically?
Journal of Gynecologic Surgery, 2016
Objective: The aim of this research was to evaluate the feasibility and surgical outcomes of laparoscopic surgery for large ovarian cysts in women <40 years of age. Materials and Methods: This was a retrospective evaluation (Canadian Task Force classification 11-2 design) of 55 women (ages <40) with large ovarian cysts (‡10 cm) with features suggestive of benign disease managed laparoscopically at Paul's Hospital, in Cochin, Kerala, from July 2006 to April 2013. All patients were followed-up for a minimum of 1 year. Patients who were diagnosed as having borderline ovarian tumors were evaluated for their present clinical status at the end of study. Results: Laparoscopic surgery was performed successfully for all patients. The mean operative time, estimated blood loss, and hospital stay were, respectively, 109.6 minutes (range: 40-255), 304.6 mL (range: 100-650), and 1.1 days (range: 1-3). Conversion to laparotomy was performed in none of the patients. Five cases of borderline malignancy were detected. Of these 5 cases; 3 underwent laparoscopic adnexectomy; 1 underwent bilateral cystectomy with staging biopsies, conceived 3 months postsurgery, and subsequently underwent laparoscopic adnexectomy at another center; and 1 underwent a unilateral laparoscopic cystectomy, and had a laparotomy and adnexectomy in another institution after 1 month. Conclusions: The current study supports laparoscopic management of large ovarian cysts as a technically feasible and effective method if proper case selection is applied. (J GYNECOL SURG 32:251
Comparison of laparoscopy versus laparotomy for the surgical treatment of benign ovarian masses
2014
From January 1998 through August, 2001, 108 women with a preoperative diagnosis of suspected ovarian dermoid cyst underwent surgical treatment at the University of Miami. Fifty-three patients underwent laparoscopic cystectomy (n ϭ 32, 61%) or laparoscopic oophorectomy (n ϭ 21, 39%) and another 55 patients had laparotomy for ovarian cystectomy or oophorectomy. Laparoscopy was performed using three or four trocars, at least one of which was placed at the umbilicus. During laparoscopic cystectomy, after separation from the ovary, the cyst was placed into an impermeable bag. The bag was removed using the largest trocar port. When the opening of the bag was completely out of the port, the contents of the cysts were drained in the bag before complete removal. If spillage occurred, lavage of the peritoneal cavity was performed until the irrigation was clear. The mean age of patients was significantly lower (27.6 years; range, 7-46 years) for the 55 women who underwent laparotomy compared with those who had laparoscopy (33.5 years; range, 19-55 years) (P Ͻ0.001). Otherwise, the two groups were comparable. Chronic pain was the most common presenting complaint (69%). Four patients presented with acute pelvic pain and 22% of patients had no symptoms. Nearly one third of patients had more than one presenting symptom. Dermoid cysts tended to be larger in women who had laparotomy (mean cyst diameter 9.75 cm) compared with the women who underwent laparoscopy (mean cyst diameter 6.52 cm) (P ϭ 0.007). Fourteen percent of the patients had bilateral cysts. Spillage of the cyst contents was much more frequent in women who underwent laparoscopy (31.4%) compared with those who had laparotomy (4.1%) (P ϭ 0.0004). The mean operating room time was significantly less for laparotomy procedures than for laparoscopy (88 minutes vs 118 minutes) (P ϭ 0.0008), but mean blood loss was greater in laparotomy procedures compared with laparoscopy (119 mL and 72 mL, respectively; P ϭ 0.002). Intraoperative laparoscopy complications included uterine perforation in two women, enterotomy in one patient, and cystotomy in one laparotomy patient. There were more postoperative complications in laparotomy patients (n ϭ 8) than in the laparoscopic group (n ϭ 2). In the laparoscopic group, one patient had a postoperative wound infection and one woman developed a hernia. Among laparotomy patients, there were four postoperative wound infections, one urinary tract infection, two postoperative fevers, and one death. The woman who died was obese with a 24-cm partially infracted dermoid cyst and died the day after surgery of cardiac arrhythmia. Nine (17%) patients undergoing laparoscopy were converted to laparotomy, four because of the large size of the mass and five as a result of adhesions. Nine patients with pain and cyst torsion underwent laparotomy. Laparoscopy was significantly more commonly associated with dermoid cyst spillage, even when adjustments were made for cyst size, oophorectomy, and cystectomy. No patient in this series developed peritonitis.
Laparoscopic Treatment of Ovarian Cysts in Adolescents and Young Adults
Journal of Pediatric and Adolescent Gynecology, 2011
To investigate the laparoscopic management of ovarian cysts in adolescents and young adults. A retrospective chart review study. Zekai Tahir Burak Women&amp;amp;amp;#39;s Health Research and Education Hospital. A total of 282 females aged 25 years or younger underwent laparoscopic surgery for a presumed benign ovarian cyst. Patients were grouped as adolescents (ages 12-19, n = 79) or young adults (ages 20-25, n = 203). Surgical approach, operative findings and the correlation of intraoperative diagnosis with the definitive pathological reports. The mean age of the patients was 21.2 years. At laparoscopic surgery, 89 patients (31.6%) had endometriomas, 47 (16.7%) had dermoid cysts, and 37 (13.1%) had paraovarian cysts. Ninety-seven patients (34.4%) had simple ovarian cysts. Pathological reports revealed that young adults were more likely to have endometriomas (34.0% vs 7.6%, P &amp;amp;amp;lt; 0.01), but dermoid cysts and simple ovarian cysts were more frequent (20.3% vs 15.3%, P &amp;amp;amp;lt; 0.01 and 60.7% vs 40.9%, P &amp;amp;amp;lt; 0.01, respectively).in adolescents. Eleven of the cases (3.9%) were found to have mucinous cystadenomas and fourteen (5.0%) to have serous cystadenomas. Four cysts were malignant (1.4%). Cystectomy was performed in 205 cases (72.7%), fenestration of cyst wall was performed in 53 cases (18.8%), and aspiration was applied in 22 cases (7.8%). The types of operation were not significantly different among adolescents and young adults (P &amp;amp;amp;gt; 0.05). The operative diagnosis was highly correlated with the final pathological reports (kappa value= 0.901, P &amp;amp;amp;lt; 0.001). There were no operative and postoperative complications in our series. With a careful preoperative screening, the laparoscopic surgery of ovarian cyst is an efficient and safe treatment for adolescents and young adults.
Laparoscopic management of giant ovarian cyst in young woman: a case report
International journal of reproduction, contraception, obstetrics and gynecology, 2018
Giant ovarian cysts are very rare nowadays and were conventionally treated by full midline laparotomy. In recent years, the laparoscopic approach is also practiced but it needs a lot of expertise and only a few cases have been reported. As the surgical treatment of choice has become less invasive, laparoscopic surgery is considered more beneficial over laparotomy because of better cosmetic results, less blood loss, reduced postoperative analgesic requirement, early mobilization and faster discharge from the hospital and early resumption to normal day to day activity. We report a case of laparoscopic extirpation of a giant right ovarian cyst measuring 15 × 21 × 22 cm in young 24-year female.
Comparison of laparoscopy versus laparotomy for the surgical treatment of ovarian dermoid cysts
Gynecological Surgery, 2005
To compare laparoscopy with laparotomy for the surgical management of ovarian dermoid cysts, a retrospective analysis of data of 108 patients who had surgery at our institution from January 1998 to August 2001 was performed. The surgical data of these patients were obtained from a computerized data base. The following data were abstracted: the patients' demographic features, size of dermoid cysts, spillage rate, estimated blood loss, operative times, duration of hospital stays, and intraoperative or postoperative complications. Statistical techniques included Student's t-tests, Fisher's exact tests, Mann-Whitney tests, and chi-square analysis. Of 108 patients with dermoid cysts, 53 (49.1%) underwent laparoscopy and 55 (50.9%) had laparotomy. The mean estimated blood loss was significantly less in laparoscopy (71.6±63.5 ml) compared with laparotomy (119.2±101.6 ml). Hospital stay was significantly shorter in the laparoscopy group (0.6±0.8 days) compared with the laparotomy group (2.2±1.0 days). Also, the postoperative complication rate was lower in the laparoscopy group (3.8%) compared with the laparotomy group (14.5%), but the difference did not reach statistical significance. Whereas the laparotomy group's spillage rate of 4.1% and operative time of 86.7±39.6 min were significantly lower than the laparoscopy group's spillage rate of 31.4% and operative time of 118.4±51.5 min, the laparoscopy group had less blood loss, shorter hospital stay, and fewer complications. The laparoscopic management of benign cystic teratomas can be safely performed.
Acta medica Iranica, 2014
Currently, laparoscopic cystectomy is the first-line therapy for ovarian benign cysts that are resistant to current therapies. There are different studies that point to ovarian reserve damage due to laparoscopic cystectomy. In this study, we evaluate the ovarian damage following laparoscopic cystectomy for non-endometriosis cysts using ultrasound and pathology findings. This is a prospective cohort study conducted between 7 rd month of 2011 and 10th month of 2012 in Women hospital affiliated to Tehran university of medical sciences.45 non-endometriosis cysts (17 teratoma,7 mucinous, 10 simple serous and 11 simple cysts) underwent laparoscopic cystectomy with stripping technique. Amount of excised parenchyma, number of lost oocytes and cyst wall fibrosis thickness were histopathologically studied. Before and 3 months after surgery antral follicle count was evaluated by ultrasound. AFC after cystectomy for teratoma and simple serous was significantly reduced P<0.05. By larger terat...
Laparoscopic approach to ovarian dermoid cysts
Chirurgia (Bucharest, Romania : 1990)
Ovarian dermoid cysts (mature cystic teratomas) are a benign type of germ cell tumours and the most common ovarian neoplasms in women of fertile age. The aim of this study was to analyze the safety of the laparoscopic approach in ovarian dermoid cysts. We performed a prospective study between 2006 and ' 2010 including 38 mature cystic teratomas treated either laparoscopically or by open access. All preoperative and postoperative data were included in an MS Access database and statistically analysed with SPSS v. 17 for Windows. The study group was divided into 2 subgroups according to the approach: laparoscopic (25 cases - 2 conversions) and classic (13 cases). The mean age of the patients was 40.34 years (range 19-74): 36.92 years for laparoscopic group and significantly higher 46.21 years for open approach group. Twelve cases were admitted as emergencies either because of complications (torsion or rupture of the teratoma) (11 cases) or associated with acute appendicitis (one ca...