Policy Statement: Guidelines for the Laparoscopic Management of the Adnexal Mass

Abstract

In recent years, advances in minimally invasive surgery have modified the management of the adnexal mass. Laparoscopic surgery offers advantages over conventional laparotomy which are beneficial to the patient and society: minimal scarring, decreased pain, and shorter hos-pitalization and recovery times. Consequently, this surgical approach has gained widespread popularity. More recendy, reports of undiagnosed ovarian cancers managed laparoscopically with unfortunate consequences have been published. These cases have prompted a re-evaluation of the management of the adnexal mass. Although most adnexal masses are benign and can be managed by hparoscopy, the challenge that remains is how to identify the ones which would be managed best by laparotomy. The objective of this guideline is to define, based on published data, clinical and surgical criteria which could help to distinguish a high-risk from a low^risk adnexal mass. There are two steps in the evaluation of the adnexal mass: the pre-operative and the intra-operative assessments. These will be reviewed in detail in this guideline. Observing strict criteria and using rigorous surgical technique will ensure the appropriate management of most adnexal masses.