Laparoscopic extracorporeal cystectomy in the management of large dermoid cysts

Abstract

Objective To evaluate the results of the surgical management of large dermoid cysts by laparoscopic extracorporeal cystectomy. Design The results of the surgical management by laparoscopic extracorporeal cystectomy of large (≥8 cm) dermoid cysts in 21 women, were evaluated in a retrospectively designed study. Setting Ankara University School of Medicine, Obstetrics and Gynaecology Clinic. Intervention After the cyst had been aspirated and decompressed, it was pulled out through the trocar site, the 10-mm suprapubic trocar incision having been enlarged to 25 mm. The aim of this was better identification of functional ovarian tissue and extracorporeal completion of cystectomy. The remaining ovarian tissue, that appeared to be functional, was pushed back into the peritoneal cavity. The duration of hospitalization, operating time, intraoperative blood loss and postoperative morbidity were evaluated. Results All of the large cysts were managed successfully by laparoscopic extracorporeal cystectomy. The mean age of the patients was 28.5 ± 4.9 years (range 21–37). The mean diameter of the cysts was 11.2 ± 2.7 cm (range 8–17 cm), the mean operation time was 65.8 ± 13.9 min (range 45–95 min), and the mean duration of hospitalization was 1.8 ± 0.7 days (range 1–3 days). Average blood loss was less than 35 ml. Despite considerable efforts to keep leakage of cyst contents to a minimum, this did occur to some extent and was managed successfully by copious lavage in all patients. None of the patients developed postoperative morbidity associated with chemical peritonitis. Conclusion Laparoscopic extracorporeal cystectomy is a safe and effective technique in the management of large dermoid cysts. Functional ovarian tissue could be well identified and preserved by direct visualization.