Abstract
Objective: The aim of this study was to review the characteristics of patients who underwent laparoscopic removal of giant ovarian cysts using the Alexis Laparoscopic System® and confirm the safety and feasibility of this technique.Method: We conducted a retrospective review of data of women undergoing the procedure from March 2014 to February 2019. Inclusion criteria were ovarian cysts of at least 15 cm. Exclusion criteria were the presence of solid components and suspicion of neoplasia on imaging.Results: Six patients were included in the series. Median size of the cysts at imaging was 22.8 cm (range 15–30 cm), while median volume was 5.9 L (range 1.9–15.6 L). Mean age of operated women was 59 years (range 21–88 years). All patients underwent exclusive laparoscopic management except one patient who underwent a conversion into midline laparotomy. The size of the skin incision initially performed to puncture the cyst ranged from 2.5 to 4 cm. On final pathological reports, two cysts were mucinous cystadenomas, and four were serous cystadenomas. There was no epithelial ovarian cancer or borderline tumor in any of the specimen operated.Conclusion: Laparoscopic management of giant ovarian cysts using the Alexis Laparoscopic System® is safe and feasible in well-selected cases. Midline laparotomy can thus be avoided, decreasing the risk of post-operative complications and increasing quality of life of patients.
Highlights
Benign giant ovarian cysts over 15 cm are rarely encountered nowadays because most are diagnosed and treated at an early stage
Laparoscopy is the treatment of choice in most benign ovarian cysts, but cyst size can be a limiting factor
Some case reports have been described in the literature with different surgical techniques to limit possible intra-abdominal spillage, but none of these procedures are suitable for giant cysts occupying the entire abdominal cavity [1,2,3,4,5,6]
Summary
Benign giant ovarian cysts over 15 cm are rarely encountered nowadays because most are diagnosed and treated at an early stage. Standard surgical management requires a midline laparotomy to minimize the risk of cell spillage in case of unexpected malignancy. This surgical technique, though oncologically safe, is associated with an increase in morbidity, especially post-operative pain, as well as an increase in hospital length of stay. Giant Ovarian Cysts: Laparoscopic Management of a minimally invasive approach because of the difficulty in creating a pneumoperitoneum as well as a decrease in visibility and surgical mobility. Both of these factors can increase the risk of intraoperative spillage because of unintentional cystic rupture. Some case reports have been described in the literature with different surgical techniques to limit possible intra-abdominal spillage, but none of these procedures are suitable for giant cysts occupying the entire abdominal cavity [1,2,3,4,5,6]
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