An easy new approach to the laparoscopic treatment of large adnexal cysts

Abstract

We describe a technique for laparoscopically assisted extracorporeal cystectomy or adnexectomy of large adnexal cysts without spillage of the cyst contents. At open laparoscopy, a suction tube decompressed the adnexal cyst from the 2-cm umbilical incision and the puncture hole was closed by the purse string tie, which was followed by extra-corporeal excision of the cyst. With this method, we prevent cyst spillage in three ways. Firstly, the cyst is aspirated extracorporeally. Secondly, when the cyst is totally collapsed, the puncture point is closed with a 1-o Vicryl purse suture and pulled to the umbilicus. Thirdly, as soon as a part of the mass is delivered from the abdomen, it is lined with moist gauze. This method provides excellent visualization and control of the penetration site during aspiration, and minimizes the chances of the cyst contents leaking into the peritoneal cavity. This method was successfully used with 12 patients, including four cystadenomas, one serous cystadenoma, three dermoid cysts (with one pregnant woman who successfully spontaneously delivered a normal baby at term), two low malignant potential ovarian tumors and one grade I endometrioid adenocarcinoma. The cancer patient has shown no recurrence after a follow-up of three years.