Laparoscopic Cystectomy in Pregnancy: Viability in a 9,9 × 7,5 Inches Lesion

Abstract

Study Objective Voluminous ovarian cysts during pregnancy constitute a rare and challenging situation. Minimally invasive techniques can potentially provide safe and effective removal without compromising the fetus. This video demonstrates a case of a 28 years old and 17-week pregnant patient with a 9.9 inches ovarian cyst with thin septae managed by laparoscopy. Design This video demonstrates a case of a 28 years old and 17-week pregnant patient with a 9.9 inches ovarian cyst with thin septae managed by laparoscopy. The patient had a prior salpingo oophorectomy and a strong fertility desire. We started evacuating the cyst content, without content spillage to the peritoneal cavity. Setting We start with a first entry under direct view in the upper left quadrant with an 11mm trocar millimeters (mm). After retrieving 2.5 gallons of clear fluid liquid, the cyst was kept attached to the abdominal wall until empty, and evaluation of the abdominal cavity was performed. An umbilical 11mm port and 3 other 5mm accessory ports were inserted. Patients or Participants Directly selected after analysis of exams and patient's desire. Interventions An incision was performed with a monopolar hook and scissors, with a careful dissection of the plane between the cyst wall and a normal ovarian parenchyma. The cyst was completely removed, and a significant amount of this single ovarian tissue was preserved. Total time was 183 min, total blood loss was 150 cc, and the patient was discharged next morning. An ultrasound confirmed fetal vitality before and after surgery. Measurements and Main Results Surgery occurred uneventfully with ovarian preservation. The pregnancy was uneventful and a healthy child was born at 38 weeks, weighing 3.6 kilos. The final anatomopathological report consisted of a borderline mucinous tumor, with an intact capsule. Conclusion This video demonstrates that laparoscopic cystectomy is feasible for large ovarian cysts, during pregnancy, if oncologic rules are followed. Voluminous ovarian cysts during pregnancy constitute a rare and challenging situation. Minimally invasive techniques can potentially provide safe and effective removal without compromising the fetus. This video demonstrates a case of a 28 years old and 17-week pregnant patient with a 9.9 inches ovarian cyst with thin septae managed by laparoscopy. This video demonstrates a case of a 28 years old and 17-week pregnant patient with a 9.9 inches ovarian cyst with thin septae managed by laparoscopy. The patient had a prior salpingo oophorectomy and a strong fertility desire. We started evacuating the cyst content, without content spillage to the peritoneal cavity. We start with a first entry under direct view in the upper left quadrant with an 11mm trocar millimeters (mm). After retrieving 2.5 gallons of clear fluid liquid, the cyst was kept attached to the abdominal wall until empty, and evaluation of the abdominal cavity was performed. An umbilical 11mm port and 3 other 5mm accessory ports were inserted. Directly selected after analysis of exams and patient's desire. An incision was performed with a monopolar hook and scissors, with a careful dissection of the plane between the cyst wall and a normal ovarian parenchyma. The cyst was completely removed, and a significant amount of this single ovarian tissue was preserved. Total time was 183 min, total blood loss was 150 cc, and the patient was discharged next morning. An ultrasound confirmed fetal vitality before and after surgery. Surgery occurred uneventfully with ovarian preservation. The pregnancy was uneventful and a healthy child was born at 38 weeks, weighing 3.6 kilos. The final anatomopathological report consisted of a borderline mucinous tumor, with an intact capsule. This video demonstrates that laparoscopic cystectomy is feasible for large ovarian cysts, during pregnancy, if oncologic rules are followed.