A Novel Hybrid Laparoscopic\u2013Extracorporeal Technique for Fertility-Preserving Management of Large Benign Ovarian Cysts: A Case Report

50 Years Ago in The Journal of Pediatrics: A ruptured ovarian cyst in a newborn infant

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 detec...

To evaluate the role of adrenal steroids in pseudoprecocious puberty due to large ovarian follicular cysts, we studied the serum 17-hydroxyprogesterone response to a combination of dexamethasone suppression followed by iv ACTH administration in two girls and compared the results to those in girls with premature thelarche, normal prepubertal girls, and a girl with true precocious puberty. Although basal serum 17-hydroxyprogesterone levels were normal in all subjects, there was incomplete suppression of 17-hydroxyprogesterone with dexamethasone in the two girls with pseudoprecocious puberty and large ovarian cysts. The 17-hydroxyprogesterone response to ACTH was much greater in these girls (360 and 540 ng/dl) than in the girls with other types of precocious puberty (mean +/- SD, 71 +/- 15 ng/dl) or in normal prepubertal girls (80 +/- 20 ng/dl). The girls with large ovarian cysts had decreased gonadotropin responses to GnRH, which were reversed subsequent to removal of the cyst. Removal of the ovarian cysts also restored the dexamethasone suppressibility of serum 17-hydroxyprogesterone and abolished the progression of pubertal development. However, 17-hydroxyprogesterone responses to ACTH were still elevated (160 and 350 ng/dl). Preoperatively, both girls had increased levels of dehydroepiandrosterone sulfate, 16-hydroxydehydroepiandrosterone sulfate, and another unidentified steroid sulfate. These steroid sulfates were also found in the cyst fluid from the one patient from whom the fluid was obtained. These results suggest that steroid production by the adrenal gland may stimulate the development of small ovarian cysts (which may be present in normal prepubertal girls) into large ovarian cysts capable of causing gonadotropin-independent precocious puberty.

Object: Abdominal laparotomy is often performed to treat large ovarian endometrial cysts. We determined the safety and feasibility of performing laparoscopic resection for large endometrial ovarian cysts.Design: A retrospective cohort study. Methods: Between June 2005 and August 2013, we performed laparoscopic surgery in 534 patients with endometrial ovarian cysts at the Yotsuya Medical Cube Women's Center. Patients with ovarian endometrial cysts were divided into the large-cysts ( ≥ 10 cm) and normal-size cysts ( < 10 cm) groups. In cases of large ovarian endometriosis with severe adhesion, we performed laparoscopic-assisted ovarian cystectomy (LAC) using double balloon catheters, which combined intra- and extra-abdominal procedures with small incisions instead of a large open laparotomy. We compared the rates of operative complication, operative time, amount of bleeding, and pathological findings between the two groups.Results: We performed laparoscopic surgery in 45 patients with large ovarian cysts. More patients had high serum CA-125 scores and r-ASRM scores in the large-cysts group than in the normal-size cysts group. Patients in the large-cysts group had severe endometriosis, and we performed the LAC procedure in 14 patients of this group. The average operative time and amount of bleeding were increased in the large-cysts group compared with the normal-size cysts group. However, there were no differences in the operative complications between the groups.Conclusion: We performed laparoscopic cystectomy in 45 cases of large severe endometrial cysts without complications. These results suggest that laparoscopic management of large endometrial ovarian cysts is safe and feasible.

Background: Ovarian cysts are common in women of reproductive age and can vary from simple functional cysts to large benign or malignant neoplasms. Giant ovarian cysts are rare and may contribute to infertility due to mechanical and hormonal disruptions. Objective: To report the diagnosis and management of a giant ovarian cyst in a young woman with long-standing primary infertility, emphasising the importance of individualised surgical planning for fertility preservation. Case presentation: A 26-year-old nulligravida woman presented with progressive abdominal distension over three months. Imaging showed a 22 cm cystic adnexal mass with suspicious features and elevated CA-125 (84 U/mL). The patient underwent exploratory laparotomy and bilateral salpingo-oophorectomy. Histopathological examination confirmed a benign serous cystadenoma. The patient recovered well and was referred for fertility counselling. Conclusions: Early evaluation and careful management of large ovarian cysts are crucial in reproductive-age women with infertility. Although tumor markers and imaging guide diagnosis, histopathology is definitive. Surgical decisions must balance oncologic safety and fertility potential to optimise patient outcomes.

CHASALOW, FRED I.; GRANOFF, ALICE B.; TSE, THOMAS F.; BLETHEN, SANDRA L. Author Information

We describe a technique for the management of large benign ovarian cysts by single incision laparoscopic surgery (SILS) through the umbilicus. The paucity of intra-abdominal working space in large ovarian cysts poses a technical challenge. Moreover, difficult convergence of operating instruments and competition for operating space outside the abdomen during the SILS makes the procedure quite demanding, especially with the conventional instruments. The concept of providing traction by taking sutures from the abdominal wall, as done in SILS laparoscopic cholecystectomy, was applied for SILS cystectomy in large ovarian cysts. Two sutures taken through the abdominal wall and then through the cyst wall provide excellent traction and “hang” the cyst from the abdominal wall, making it convenient to dissect and operate. This technique demonstrates that SILS ovarian cystectomy is feasible, safe and technically unchallenging even in large benign ovarian cysts.

Background: Due to their age and life stage, young women with breast cancer (YWBC) encounter distinct challenges related to their diagnosis and treatment. Unmet parity along with potential premature ovarian insufficiency represent a notable concern among this group of patients. Effective strategies to address this issue include fertility preservation techniques, as well as temporary ovarian suppression with gonadotropin-releasing hormone agonists (GnRHa) for ovarian protection during cytotoxic treatments. Here we report a comparative analysis of two prospective studies describing the rates and factors associated with fertility and ovarian function preservation choices in YWBC from two countries. Methods: Women with BC at an age ≤40 years were prospectively accrued in the Joven &amp; Fuerte and PREFER multicenter cohorts in Mexico and Italy, respectively. These studies provide early referrals to fertility and/or ovarian function preservation strategies at diagnosis as needed. This analysis comprised YWBC diagnosed from 2014-2019 whose treatment included chemotherapy (CT) with the objective of identifying their uptake of fertility and ovarian function preservation options. Patients’ characteristics within and across cohorts were compared using chi-squared, Fisher’s exact, and Wilcoxon tests. Simple logistic regression was conducted to calculate the likelihood of undergoing fertility preservation. Results:In total, 485 patients were included: 361 (74%) in Mexico and 124 (26%) in Italy. Median age at diagnosis was 35 years (IQR 32-38) in both cohorts. A higher proportion of Mexican patients had a partner compared to Italian patients (65% vs 59%, p=.04). Patients’ median number of children at diagnosis was also higher in Mexico than in Italy (1 [IQR 0-2] vs 2 [IQR 1-3], p&amp;lt;.001). Patients’ distribution by clinical stage (p&amp;lt;.001), timing of CT (p=.01), hormone receptor status (p=.04), and HER2 status (p=.002) also differed between cohorts: Mexican patients were more frequently diagnosed with stage III BC and received neoadjuvant CT, while Italian patients more commonly had positive hormone receptors or HER2 overexpression. Regarding fertility preservation, a technique was used in 8% and 25% of patients in Mexico and Italy, respectively (p&amp;lt;.001). Methods comprised oocyte (50% in Mexico vs 87% in Italy), embryo (53% vs 0%; this strategy is forbidden by law in Italy), and ovarian tissue cryopreservation (0% vs 16%). GnRHa for ovarian protection were used in nearly all Italian patients (98%) but in a minority of Mexican patients (6%). Not undergoing fertility preservation was mainly due to lack of interest (47-50%), urgency to start treatment (4-6%), and personal reasons (3-5%). Fertility preservation uptake was associated with younger age (OR 1.2, 95%CI 1.1-1.2), unpartnered status (OR 3.4, 95%CI 1.9-5.9), childlessness (OR 21.8, 95%CI 10.0-47.6), private healthcare coverage in Mexico (OR 3.0, 95%CI 1.1-8.1), stage I-II BC (OR 3.1, 95%CI 1.5-6.3), positive hormone receptors (OR 2.3, 95%CI 1.2-4.6), and adjuvant CT (OR 2.4, 95%CI 1.4-4.3). Conclusions: This comparative analysis of two prospective studies in Mexico and Italy showed that a significant distinct proportion of YWBC had access to the available fertility and ovarian function preservation techniques in these countries, possibly reflecting the different social and healthcare contexts. Although all women should receive a complete oncofertility counseling, patients who are younger, unpartnered, childless, and have earlier-stage BC appear to be those who particularly benefit from being offered fertility preservation options. This study underscores the need to enhance awareness and access to oncofertility services in order to provide comprehensive, patient-centered care to this young population. Citation Format: Fernanda Mesa-Chavez, Maria Grazia Razeti, Eva Blondeaux, Alejandra Platas, Virginia Delucchi, Alan Fonseca, Valeria Fontana, Marlid Cruz-Ramos, Paola Anserini, Manuel Rolando García Garza, Edoardo Chiappe, Alejandro Mohar, Laura Orlando, Enrique Bargallo-Rocha, Saverio Cinieri, Lucia Del Mastro, Cynthia Villarreal-Garza, Matteo Lambertini. Fertility and ovarian function preservation in young women with breast cancer: A comparative analysis of two prospective cohort studies in Mexico and Italy [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P2-03-02.

Laparoscopic surgery for large benign ovarian cysts

Background: The prevalence of functional ovarian cysts in women is high, and choosing an appropriate, and uncomplicated treatment is necessary. Objective: Compare the effectiveness of honey, olive, and propolis combined vaginal cream with OCP in the treatment of functional ovarian cysts in women of reproductive age in Iran. Methods: This randomized clinical trial study was performed on 40 women of reproductive age referred to Hamadan health centers in 2020. Patients were randomized into two groups, A and B. Group A received oral contraception pills for two consecutive cycles from the seventh day of the menstrual cycle tablets for 21 days after the end of menstruation until the beginning of the next menstruation. Group B received honey, olive, propolis combined vaginal cream. In both groups, the treatment continued for two consecutive cycles. Data was collected through a checklist that included clinical symptoms and ultrasound results. The results were analyzed by Stata-13 and the significance level cut-off was considered less than 0.05. Results: Intra-group comparisons showed that there was a statistically significant (P &lt; 0.05) decrease in cyst size after the intervention in both groups. Intergroup differences were not statistically significant (P ˃ 0.05). Conclusion: Honey, olive, propolis combined vaginal cream (Nika) can be effective like oral contraceptive pills in reducing the size of ovarian cysts. It can be recommended for the treatment of functional ovarian cysts. Clinical Trial Registration Number: IRCT20120215009014N384

Ovarian cysts are common in young women of reproductive age. It is estimated that around 7% of women worldwide experience a symptomatic cyst during their lifetime. Functional ovarian cysts (FOCs) occupy one of the leading places in the structure of gynecological diseases (45-55%) in women of reproductive age. Functional cysts are not true neoplasms and are considered as a variant of a normal physiological process.Ovarian retention formations are found in 7.8% of clinically healthy women and in every second (52.3%) patient with lower abdominal pain or menstrual cycle disorders. Studies of FOCs have mainly concerned cysts that arose after ovulation induction, studies of spontaneous follicular cysts are limited, the question of the effect of FOCs on fertility and ovarian reserve is debated.The objective: to analyze the management of patients with FOCs in real clinical practice.Materials and methods. A retrospective case-control cohort study was conducted with the participation of 350 women aged 19 to 39 years who were diagnosed with ovarian neoplasms between 2020 and 2022. Complaints, anamnesis data, applied methods of diagnosis and treatment of neoplasms were analyzed. Results. According to clinical data, the cases were divided into 3 groups. The I group included 122 (34.9%) women in whom, in the absence of symptoms and complaints, ovarian neoplasms were detected for the first time during pelvic ultrasound.The II group consisted of 116 (33.1%) female patients, who for the first time applied for an examination due to complaints of periodic unilateral pain of various nature, a feeling of discomfort in the lower abdomen.The III group included 112 (32.0%) women who were urgently hospitalized with complaints of acute pain and pressure in the lower abdomen, bloating, weakness, dizziness. Among the patients of this group, 53 (47.3%) women had ovarian neoplasms diagnosed earlier (within 2.6±0.7 years).Among the studied cohort, according to ultrasound data, functional (follicular cysts and corpus luteum cysts) ovarian cysts were verified among the detected neoplasms in 253 (72.3%) women.Conclusions. The prevalence of functional ovarian cysts in women that do not have clinical manifestations as ultrasound findings is 78.7%, among them follicular cysts predominate (66.4%). Infertility occurs in 23.8% of asymptomatic women with functional ovarian cysts. In 34.5% of women with functional ovarian cysts who have clinical symptoms, menstrual cycle disorders prevail.

Asymptomatic volunteer women with a regular pattern of uterine bleeding and using the progestogen-only oral contraceptive pill were compared with control women who were not exposed to hormones. Pelvic ultrasound scanning at the end of the next bleeding episode after recruitment demonstrated functional cysts with maximum diameters ranging between 30 and 58 mm in eight of the 21 pill users, four of whom also had palpable ovaries, three cysts regressed during the next cycle. Of the 13 women with normal ovaries initially, four developed a new functional cyst of which two were associated with pain. Of the 12 women with cysts seven complained of pain at some time during the monitored cycle. Among 21 control women only one symptom-free (42 mm) cyst was shown on the initial postmenstrual ultrasound scan and this resolved painlessly during the scanned cycle with ovulation from the opposite ovary. Ovulation was also demonstrated in 16 of the remainder; but in none of the three control women who developed asymptomatic functional cysts (35-47 mm in size) while under observation. Since 11 of the 14 pill-users who failed to ovulate also had a functional cyst, the contraceptive efficacy may depend in part on this association. Pain symptoms may make the method less acceptable and give rise to diagnostic problems and inappropriate therapies.

Introduction/BackgroundIn this video, we describe a five-step surgical technique allowing to safely incise and aspirate the content of large ovarian cysts through a single port laparoscopic incision. This allows performing...

Protected Laparoscopic Large Ovarian Cyst Aspiration: A 5-Step Alternative to Laparotomy

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.