Minimal access approach to the management of large ovarian cysts

Abstract

We read with interest the novel approach of Goh et al. [1] to laparoscopically assisted extracorporeal cystectomy for very large ovarian cysts without spillage of cyst contents. We commend their efforts. However, certain issues need to be clarified. The authors used open laparoscopy to access the abdominal cavity. We suggest the use of direct trocar insertion through Palmer s point, except when the ovarian cyst is large enough to fill the abdominal cavity, because adhesions are rare at this site [2]. The authors described a technique using a Cook aspiration needle and suction cannula to prevent the spillage of cyst contents. We suggest the use of a 5.5-mm trocar and cannula to puncture the cyst and aspirate the contents of the cyst with a suction tip, which can be placed through the same cannula after removal of trocar. In this manner, even multilocular cysts can be managed because the suction cannula is long enough to get across other cysts. We hope further discussion and suggestion will contribute to the advancement and popularity of this novel technique.