Laparoscopic Technique for Extraction of Large Abdominopelvic Masses

Abstract

<h3>Study Objective</h3> To review preoperative evaluation of a patient presenting with an abdominopelvic mass. To discuss methods of drainage and spill prevention during surgical management of large abdominopelvic masses and to demonstrate an efficient laparoscopic method for extraction of large adnexal masses. <h3>Design</h3> N/A <h3>Setting</h3> In the operating room with patient in dorsal lithotomy position with both arms tucked. Five-millimeter ports were placed in the umbilicus, the right lower quadrant and the left mid-abdomen. The specimen was extracted through an 8 mm port in the left lower quadrant. <h3>Patients or Participants</h3> 27-year-old female with a 15 × 13 cm abdominopelvic mass who presented with right lower quadrant and low back pain and mild right hydronephrosis. She had a benign appearing cyst on ultrasound and her tumor markers were negative. <h3>Interventions</h3> We employ a morcellation method we refer to as apple-peeling to cut the cyst into a long strip of 1 inch width to allow easy removal through an 8 mm laparoscopic port without spill or struggle. <h3>Measurements and Main Results</h3> N/A <h3>Conclusion</h3> Large abdominopelvic masses can be managed via laparoscopic approach with proper pre-operative work-up to ensure benign status. The apple-peeling morcellation technique demonstrated in this video allows efficient extraction of abominopelvic masses > 10 cm through small laparoscopic ports (8mm)