Laparoendoscopic Single-Site Surgical Techniques for Management of Adnexal Masses in Pregnancy

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Study Objective To demonstrate key techniques that can be utilized in laparoendoscopic single-site surgery (LESS) for removal of an adnexal mass in pregnancy. Design This video demonstrates skills for removal of an adnexal mass in pregnant patients using LESS. If able to be contacted, patients were followed until delivery. Setting All surgeries were performed at an academic hospital. Patients or Participants Three pregnant women who each required removal of an adnexal mass underwent LESS. First, a 30-year-old G1P0 presented with a persistent 7.1 cm simple ovarian cyst concerning for torsion. Second, a 21-year-old G2P0010 had a 17.4 cm benign ovarian mucinous cystadenoma. Third, a 32-year-old G3P2002 presented with a 10.5 cm complex adnexal mass. Interventions LESS was performed in three pregnant women. An adnexal mass can be removed through the single-site umbilical incision with several key techniques that can be applied to enhance and simplify LESS in pregnancy: (1) gauze placement under a simple ovarian cyst to absorb spillage and to isolate the cyst in order to prevent inadvertent injury; (2) use of V-Loc suture to reapproximate the ovarian parenchyma to preserve ovarian function and avoid difficult knot-tying; (3) extracorporeal surgical approach after drainage of cystic contents and delivery of the collapsed ovarian cyst through the incision; and (4) in-bag tissue extraction of concerning ovarian pathology at the incision. Measurements and Main Results Two simple cystectomies were uncomplicated. The third patient had an uncomplicated oophorectomy after intraoperative pathology revealed a stage IIIA germ cell tumor. The first and third patient had full-term uncomplicated vaginal deliveries, and the second was lost to follow-up at 35 weeks. Conclusion LESS in a gravid uterus is technically challenging due to loss of triangulation of instrumentation. Application of the techniques demonstrated in this video can simplify LESS for removal of an adnexal mass in pregnant women with preservation of pregnancy and resolution of symptoms.