Laparoscopic management of adnexal postmenopausal masses

Abstract

Laparoscopic treatment of ovarian masses remains controversial. We strongly suggest that laparoscopic diagnosis of adnexal postmenopausal cysts can be safe, reliable, and successful. Until a few years ago, radical treatment by laparotomy was recommended for palpable ovaries in postmenopausal women because of the high risk of malignancy. We think that accurate preoperative screening together with strict intraoperative criteria can discriminate benign from malignant adnexal masses. Many sophisticated technologies are available to evaluate ovarian pathology, such as laboratory tests, ultrasound, color Doppler, computerized tomography, and magnetic resonance imaging. They allow more accuracy in patient selection for laparoscopy, which remains the major tool in the diagnosis of adnexal masses. Between June 1993 and October 1994 we treated 18 postmenopausal women with adnexal cysts by laparoscopy. Patients were selected following strict criteria of evaluation to exclude malignancies. The first step was careful history and physical examination, ultrasound evaluation with vaginal probe, and serum CA125 measurement. The second step was laparoscopic diagnosis with cytologic examination of the peritoneal fluid and accurate inspection of the entire abdominal cavity. We always performed bilateral adnexectomy with intraoperative frozen sections; in case of malignancy we performed an immediate laparotomy. The adnexae were extracted by abdominal endopatch to avoid spillage and dissemination. In our series no adnexal cancer was misdiagnosed, and laparoscopic treatment was performed only for benign masses.