Removal of Ovarian Dermoid Cyst via Posterior Cul-de-Sac

Abstract

Background: Most women who develop dermoid cysts are of reproductive age and require conservative fertility-sparing surgery. The surgical approach to a dermoid cyst was cystectomy via laparotomy until the laparoscopic surgery was developed. However, this approach may induce spillage of cyst contents into the peritoneal cavity, although risk of this complication has been reduced with technical advances. The vagina offers direct access to the peritoneal cavity and to any existing ovarian cyst. One vaginal approach is via the posterior cul-de-sac. Objective: The aim of this retrospective study was to investigate surgical management of ovarian dermoid cysts via the posterior cul-de-sac. Materials and Methods: This study was conducted in a gynecologist's private clinic. Thirty women with dermoid cysts were operated on vaginally via the posterior cul-de-sac without laparoscopic assistance. Preoperatively, the patients were counseled and written content was obtained for the surgery to be performed vaginally unless required otherwise, with preparations made to utilize laparoscopic assistance or, if necessary, even open the abdomen. After careful clinical examination and assessment under anesthesia, each patient's dermoid cyst was accessed via the posterior cul-de-sac and excised. Results: The vaginal route without laparoscopic assistance was successful in 29 women; 1 woman required laparoscopic assistance through a single port to push her dermoid cyst into the pouch of Douglas to make it accessible. To conserve the women's fertility, ovarian cystectomies were performed and healthy ovarian tissue was preserved. The postoperative hospital stay was 24 hours. No disposable equipment or instruments were used in the surgery. Conclusions: The vaginal route offers an excellent alternative to laparoscopic surgery and eliminates, in most cases, the need for invasive laparotomy. The vaginal route has the advantages of minimal invasion, shorter hospital stay, rapid recovery, and being the most economical option. (J GYNECOL SURG 31:8)