Blue to Pink in 10 Minutes: Fallopian tube and Paratubal Cyst Torsion. Case Presentation and Demonstration of Dissection Principles

Abstract

<h3>Study Objective</h3> To demonstrate immediate changes in fallopian tube appearance upon detorsion. To encourage fallopian tube preservation in circumstances of torsion, in patient at low risk of cancer and desiring future fertility. To demonstrate principles of robotic dissection and cooperation with bedside assistant. <h3>Design</h3> Video case report. <h3>Setting</h3> Tertiary Gynecologic Oncology Center. <h3>Patients or Participants</h3> 26yo desiring future fertility presenting with pelvic mass and subacute pain. <h3>Interventions</h3> Da Vinci Xi robotic surgery. <h3>Measurements and Main Results</h3> Dissection of fallopian tube from paratubal cyst and detorsion of fallopian tube took approximately 10 minutes. Immediate improvement in fallopian tube perfusion resulted in change in color from blue to pink. Since fallopian tube had been stretched, it was twice longer than usual. Fallopian tube, was attached to the ovary to keep fimbria in close proximity. Safe dissection principles including appropriate selection of instruments, creation of three-dimensional anatomy, defining surgical planes and organ borders, traction-countertraction, adjusting dissection direction to tissue response, active involvement of bedside assistant are discussed and demonstrated. <h3>Conclusion</h3> Fallopian tube detorsion should be attempted even in situations of significant change in tissue color when preservation of fertility is desired, and risk of cancer is low. Fixation of fallopian tube or ovary to prevent repeat torsion is controversial. Studies report preservation of ovarian function in 90% of detorsion cases. Tissue falling apart during handling suggests necrosis and requires removal, as it may result in peritonitis and sepsis.