Excision Of Ovarian Cysts Research Articles

Sphingosine-1-phosphate protects human ovarian follicles from apoptosis in vitro

Objective(s)We aimed to analyze if anti-apoptotic agent sphingosine-1-phosphate offers protection against in vitro follicle atresia during culture of human ovarian cortical samples. Study designA translational research study of ex-vivo and in-vitro models of human ovarian tissue. Material and methodsOvarian cortical tissue fragments (1 × 0.5 cm) were obtained from young patients (n = 15 mean age ± SD: 29.4 ± 2.5) undergoing laparoscopic excision of benign ovarian cysts. The samples were cultured for 4 days in 24-well format culture plate using conventional culture techniques. S1P was added to culture media at 200 and 400 μM concentrations. At the end of culture period the samples were processed for both histomorphological assessment and detection of apoptosis with immunohistochemistry and western blot methods using apoptosis marker cleaved caspase-3. In vitro estradiol (E2) and AMH productions of the samples were measured with ELISA. Follicle counts were expressed as the mean number of follicles per mm2. ResultsThe mean numbers of primordial and secondary follicles were 3.2 ± 0.4 and 0.7 ± 0.2 respectively, in the fresh fixed uncultured samples. After four days of culture their numbers were significantly decreased to 0.8 ± 0.2 (p < 0.01) and 0.1 ± 0.05 (p < 0.05) respectively, in the control samples cultured without S1P compared to fresh fixed samples. S1P treatment decreased follicle atresia and significantly higher number of primordials (2.3 ± 0.3, p < 0.01) and secondary follicles (0.5 ± 0.1, p < 0.05) survived in the samples after 4 day culture period compared to those cultured without S1P. In line with this there was dose-dependent decrease in the protein expression of cleaved caspase-3 on western blot and in the number of apoptotic follicles stained positive for cleaved caspase-3 on immunohistochemistry in the samples incubated with S1P at 200 and 400 μM concentrations. Furthermore, those samples incubated with S1P produced significantly higher amounts of E2 (2339 ± 321 vs. 1156 ± 125 pg/mL respectively, p < 0.01) compared to control samples. ConclusionsThese results suggest that S1P promotes follicle survival in human ovarian cortical samples in vitro.

Robotic excision of ovarian dermoid cysts in an endoscopic pouch: fostering the practice of contained tissue extraction in gynecologic surgery

Robotic excision of ovarian dermoid cysts in an endoscopic pouch: fostering the practice of contained tissue extraction in gynecologic surgery

Management and outcomes of vaginal bleeding and heavy menstrual bleeding in women of reproductive age on direct oral anti-factor Xa inhibitor therapy: a case series

Observational data and results from post-hoc analyses in clinical trials suggest that direct oral factor Xa inhibitors might increase menstrual bleeding intensity in women of reproductive age, but the extent of this effect is unknown. We aimed to investigate the management and outcomes of vaginal bleeding complications during therapy with direct oral factor Xa inhibitors in a case series of women of reproductive age. To identify individuals for inclusion in this case series, we searched two sources of prospectively collected data from women of reproductive age treated with direct oral factor Xa inhibitors: the non-interventional Dresden NOAC Registry (NCT01588119), which is based in the administrative district of Dresden (Saxony, Germany), and all locally archived data from phase 3 trials of direct oral factor Xa inhibitors done at University Hospital Carl Gustav Carus Dresden. Vaginal bleeding events were defined as any vaginal bleeding complications as reported by the patient. We collected data on type and dosage of anticoagulation; suspected or confirmed bleeding events, hospital admissions, and mortality; and pattern and management of vaginal bleeding events. For all cases of bleeding identified, we reviewed all available source data to identify examination results suggesting potential underlying anatomical causes of bleeding. We identified 178 women of reproductive age who received direct oral factor Xa inhibitor therapy, of whom 57 had vaginal bleeding events, including 50 who received rivaroxaban, six who received apixaban, and one who received edoxaban. These 57 women had 72 vaginal bleeding events, including 59 cases of heavy menstrual bleeding and 13 bleeding events unrelated to the menstrual cycle. 51 (86%) of these heavy menstrual bleeding events (two major bleeding events, 17 clinically relevant non-major bleeding events, 32 minor bleeding events) were treated conservatively (eg, change of oral hormone therapy or reduction, temporary interruption, or discontinuation of direct oral factor Xa inhibitor) and the remaining eight (14%) events (three major bleeding events and five clinically relevant non-major bleeding events) required elective surgical or interventional treatment (hysterectomy, curettage, ovary excision, or excision of ovarian cysts). Of the 57 women, 13 (23%) had a second bleeding event and two (4%) had a third event. Nine patients had underlying anatomical abnormalities; compared with patients without abnormalities, these patients had more intense bleeding, more had recurrent bleeding (five [56%] of nine patients with abnormalities vs eight [17%] of 48 patients without abnormalities), and more needed surgical treatment for bleeding (eight [89%] of nine vs zero of 48). Vaginal bleeding, particularly heavy menstrual bleeding, is a common complication in women of reproductive age on direct oral factor Xa inhibitor therapy. Most cases can be treated conservatively, but patients with severe or recurrent vaginal bleeding complications should be assessed for underlying anatomical abnormalities, which might require surgical or interventional treatment. Further data are needed to provide guidance on prevention and treatment of vaginal bleeding complications in this patient population. None.

The Effect of Bipolar Electrocoagulation During Ovarian Cystectomy on Ovarian Reserve

Abstracted from Amer J Obstet Gynecol 2015;213:620–628 Laparoscopy is considered the criterion standard for excision of nonmalignant ovarian cysts.

Effect of ovarian dermoid cyst excision on ovarian reserve and response: Insights from in vitro fertilization

Abstract Study objective To investigate the impact of an ovarian dermoid cyst or dermoid cyst surgery on ovarian reserve in patients undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Design We performed a retrospective cohort study by using the records of patients with a history of ovarian dermoid cyst who underwent IVF/ICSI between 2009 and 2013. The antral follicle count (AFC) obtained by transvaginal ultrasound during controlled ovarian hyperstimulation of IVF/ICSI, total number of basal follicles [i.e., basal antral follicle count (B-AFC)], and dominant follicles greater than 1.4 cm [i.e., dominant antral follicle count (D-AFC)] were calculated between the different groups. Patients We included 260 patients with a history of dermoid cyst excision and 23 patients with a dermoid cyst who underwent IVF/ICSI. Two hundred and eighty-three matched patients without a dermoid cyst and ovarian surgery history were included. Intervention None. Measurements and main results The B-AFC was significantly smaller in the dermoid cyst group than in the matched control group ( p = 0.030). The B-AFC and D-AFC were both significantly smaller for the previously operated ovary than for the contralateral nonoperated ovary ( p = p = 0.018 and p = 0.004, respectively). The B-AFC and D-AFC were significantly fewer in ovaries treated by open surgery than in ovaries treated laparoscopically ( p = 0.031 and p = 0.028, respectively). There was no significant difference in the main IVF outcomes between the two groups or the subgroups. Conclusion Our results suggest that ovarian dermoid cyst excision could significantly reduce ovarian reserve to a similar extent as the cyst itself. The presence or resection of dermoid cysts will not affect the main IVF outcomes.

AMH trend after laparoscopic cystectomy and ovarian suturing in patients with endometriomas.

To evaluate the ovarian reserve after laparoscopic cystectomy with suturing in patients with endometriomas. A total of 80 women with unilateral or bilateral endometriomas underwent laparoscopic cystectomy using sutures for hemostasis after the excision of ovarian cysts. Serum levels of antimullerian hormone (AMH) and FSH were measured at the day 3 of menstrual cycles preoperatively, 6 and 12 months postoperatively. In the bilateral endometrioma group, serum AMH level decreased significantly from the baseline (4.68 ± 2.87 ng/ml) to 6 months (3.05 ± 1.99 ng/ml) and 12 months (2.26 ± 1.88 ng/ml) postoperatively, whereas the FSH level increased significantly from baseline to 12 months postoperatively (P < 0.05). Those patients with unilateral endometriomas also had lower levels of AMH in 6 and 12 months after operation. When compared between unilateral and bilateral endometrioma group, the rate of AMH decline 6 and 12 months and the rate of FSH increase 12 months postoperatively reached statistical significance (P < 0.05). The changes of the AMH and FSH values suggest that the ovarian reserve is obviously reduced in spite of suturing technology used as a method of hemostasis after stripping ovarian endometriomas, especially in those with bilateral cysts. The protective effect of the ovarian suturing for ovarian reserve may be marginal.

Anti-Mullerian hormone trend evaluation after laparoscopic surgery of monolateral endometrioma using a new dual wavelengths laser system (DWLS) for hemostasis

Operative laparoscopy is the gold standard in the treatment of endometriotic ovarian cysts. Excisional surgery is the best technique to prevent recurrences and improve symptoms but it may result in ovarian reserve damage due to the removal of healthy ovarian cortex. The aim of this study was to assess the impact on ovarian reserve of the use of dual wavelengths laser system (DWLS) hemostasis after stripping technique of monolateral endometrioma, by dosing the anti-Mullerian hormone (AMH). This prospective study was conducted at the Institute of Obstetrics and Gynecology, University of Foggia, from December 2013 to January 2015. Forty-five women underwent excision of monolateral endometriotic ovarian cyst by stripping without using a bipolar coagulation and performing hemostasis with a DWLS. The AMH serum levels were estimated before the surgery (T0), 4–6 weeks (T1) and 6–9 months (T2) after surgery. Our results suggest that an appropriate surgical technique with the use of laser hemostasis does not determine a significant reduction of ovarian reserve. Laser hemostasis could prevent follicular reserve loss after ovarian endometrioma surgery.

The impact on ovarian reserve of haemostasis by bipolar coagulation versus suture following surgical stripping of ovarian endometrioma: a meta-analysis

Concern is increasing that the use of bipolar coagulation or suturing to obtain haemostasis after surgical stripping of ovarian endometrioma could affect ovarian reserve. To compare the ovarian damage associated with the use of bipolar coagulation with ovarian suture as determined by anti-Müllerian hormone (AMH), FSH and antral follicle count, 21 studies were identified. Pooled analysis of 312 patients showed the average serum level of AMH was lower in the coagulation group than in the suture group (3-month follow-up: weighted mean difference (WMD) −0.75 ng/ml, 95% confidence interval (CI) −1.82 to 0.31; 6 months: WMD −1.45 ng/ml, 95% CI −2.43 to −0.47; 12 months: WMD −1.01 ng/ml; 95% CI −1.85 to −0.17), although heterogeneity was high. The weighted overall average levels of FSH between the two groups were not statistically significantly different 3 months after surgery (WMD 0.37 mIU/ml; 95% CI −1.56 to 1.30). The mean antral follicle count in the coagulation group was significantly less than in the suture group at 3 months' follow-up (WMD −2.53, with 95% CI −4.94 to −0.12). This study showed bipolar coagulation did more harm to the ovarian reserve than the suture haemostasis during excision of ovarian cyst as shown by a significant postoperative reduction in AMH.

COMPARATIVE STUDY BETWEEN LAPAROSCOPIC AND OPEN OVARIAN CYSTECTOMY ON OVARIAN RESERVE

Objective: To investigate the impact of electrocoagulation on ovarian reserve after laparoscopic excision of ovarian cysts and the possible mechanisms. Design: A prospective study. Setting: Obstetrics and Gynecology Department of a university hospital. Patient(s): 100 patients with benign ovarian cysts undergoing ovarian cystectomy. Intervention(s): Laparoscopic ovarian cystectomy using bipolar electrocoagulation and laparotomic ovarian cystectomy using sutures after the excision of ovarian cysts. Main Outcome Measure(s): Follicle-stimulating hormone (FSH & AMH) assays and transvaginal ultrasound evaluating basal antral follicle number, mean ovarian diameter, and ovarian stromal blood flow velocity at cycles 1, 3 and 6 after surgery. Result(s): When comparing the bipolar group with the suture group, a statistically significant increase of the mean FSH value was found in bilateral-cyst patients at 1-, 3- and 6-month follow- up evaluations and in unilateral-cyst patients at the 1-month follow-up evaluation. When comparing the bipolar group with the suture group, a statistically significant decrease of the mean AMH value was found in bilateral-cyst patients at 1-, 3- and 6-month follow- up evaluations and in unilateral-cyst patients at the 1-month follow-up evaluation. Statistically significant decreases of basal antral follicle number and mean ovarian diameter were found during the 3-, 6-month follow-up evaluations as well as statistically significant decreases of peak systolic velocity at all of the follow-up evaluations. Conclusion(s): Electrocoagulation after laparoscopic excision of ovarian cysts is associated with a statistically significant reduction in ovarian reserve, which is partly a consequence of the damage to the ovarian vascular system. Key Words: Ovarian cysts, laparoscopic ovarian cystectomy, electrocoagulation, ovarian reserve

Ovaryan dev kitlelere yaklaşım; jinekolojik, anestetik, patolojik yaklaşım; dört olgu sunumu

Giant ovarian masses, gynecologic, anestetic and pathologic assessment; analysis of four cases Ovarian masses sometimes can be seen as bulky masses reaching to huge amounts. Most pathologic signs can be attributed to compression effect on intraabdominal organs, vascular structures and ascites made by tumor. After removal of such huge pelvic masses, serious clinical hypotension and inferior vena cava (IVC) syndrome can be seen related to the aspiration of high levels of fluid or resection of bulky mass. Here, we present four cases of bulky ovarian masses by means of gynecologic surgery, anaesthesia and pathology. Case: 54, 35, 39, 42 years old patients having 20 kg and 40x20cm; 14 kg and 40x40x40 cm, 17 kg and 45x50 cm and 53x50 cm adnexal masses respectively were operated. Histopathologies were found each to be the first two borderline mucinous carcinomas, third one was benign endometrioid tumor and the fourth one was mucinous cystadenoma complexed with teratom structures. On preoperative assessment, patients had dyspnea and tachypnea due to huge abdominal distention, blood gas parameters were hypoxic. To prevent supin hypotensive syndrome and other complications peroperatively, cases were evaluated by anesthesiology and the appropriate anesthesia technique was chosen, no major complications were seen in the peroperative or postoperative periods. Discussion: Giant ovarian cyst excision may be associated with significant mortality. Most of the problems are due to the size of the cyst and to the patient‘s poor condition. Serious problems in this case mainly develop because of intraoperative blood loss and duration of the operation, postoperative hypotension and electrolyte disorders may be seen. Special attention should be paid to ventilator monitoring and hemodynamic assessment peroperatively and intraoperative fluid imbalance, hypotermia and coagulopathy regulation and the operative approach in the planning area needs to be done carefully.

Anti-Müllerian hormone trend after laparoscopic surgery in women with ovarian endometrioma

Operative laparoscopy is the gold standard in the treatment of endometriotic ovarian cysts. Excisional surgery is the best technique to prevent recurrences and improve symptoms but it may result in ovarian reserve damage due to the removal of healthy ovarian cortex. The aim of this study was to investigate the extent of the ovarian reserve damage after stripping technique of unilateral endometriomas, by dosing the Anti-Müllerian Hormone (AMH). This prospective study was conducted at the Center of Minimally Invasive Pelvic Surgery of the Department of Health of Woman and Child, University of Padua, from October 2010 to June 2012. Twenty-five women underwent excision of monolateral endometriosis ovarian cyst by stripping without accessing a bipolar coagulation and performing an intracortical suture. The AMH serum levels were estimated in the early proliferative phase of the cycle, before surgery (time 0), 24 h after surgery (time 1), the first menstrual cycle after surgery (time 2) and the third menstrual cycle after surgery (time 3). We found a nonstatistically significant decreases in serum AMH levels after surgical excision of the cysts. Our results suggest that an appropriate surgical technique, without the use of the bipolar coagulation of ovarian border, does not determine a significant reduction of ovarian reserve.

Laparoscopic stripping ovarian cystectomy in children without use of electrocautery in residual ovarian bed: experience in Chittagong, Bangladesh

Objective: Laparoscopic excision has now become the standard treatment option for benign ovarian cysts. Stripping is an effective and popular technique practiced by the surgeons for ovarian cyst excision. Use of electro-cautery in the residual ovarian bed is blamed for the reduction of ovarian reserve. Our experience of laparoscopic stripping technique without use of electro-cautery in the remaining ovarian tissue is described. Materials and Methods: From 1 January 2006 to 31 December 2010, 26 cases were considered for laparoscopic stripping ovarian cystectomy. Using mono-polar hook cautery a flap was marked and raised on cyst wall and serous fluid sucked out. A plane was then created between inner and outer linings of the cyst wall, and inner lining peeled off. Warm normal saline wash was then given and the stripped lining was brought out through supra-umbilical port. Patients were followed up at 15 days, 1 month, 3 months, 1 year and then yearly with ultrasonogram at 3 months and 1 year. Patient’s age, operative time and outcome, blood loss and complications were studied retrospectively. Results: Age ranged from 3.5 to 16 years. Presenting complaints included: abdominal pain (11), abdominal swelling (8) and palpable abdominal lump (7). Average operative time was 40.30 minutes and operative blood loss ranged from 10 to 36 ml. There was no intra or post-operative complication. There was no recurrence of cyst confirmed by ultrasonography at 3 months and 1 year. Conclusions: Avoiding use of electro-cautery during ovarian cystectomy by stripping technique can prevent damage and reduction in ovarian reserve. DOI: http://dx.doi.org/10.11593/bje.2013.0101.0007 Bangladesh Journal of Endosurgery Vol.1(1) January 2013: 26-28

Laparoscopic Management of Large Ovarian Cysts

The aim of this study was to describe a new technique for laparoscopic removal of large ovarian cystic masses. The authors performed a retrospective study during the period January 2008 to December 2009 in the Second Department of Obstetrics and Gynecology of Aretaieion University Hospital; 19 women with large ovarian cysts were included in the study. During the study period, 53 women underwent laparoscopic excision of ovarian cysts. Among them, 19 had very large complex ovarian cysts with a mean diameter of 8.4 cm. The mean age of the patients was 32.1 years. Ultrasound examination revealed findings suggestive of benign disease in all patients. In 8 out of 19 patients CA-125 levels were elevated, ranging from 40.5 to 194.7 IU/mL. A 5-mm suprapubic trocar was directly inserted into the cyst and fluid contents aspirated, so the decompressed cyst could fit in a 5-cm laparoscopic bag. The cyst wall was carefully detached from the healthy ovarian tissue and placed in the bag without any spillage. The remaining cyst wall was removed from the peritoneal cavity with the laparoscopic bag. The mean operative time was 45 minutes. No operative or postoperative complications were noted. There was no conversion to laparotomy. Mean hospital stay was 1 day. Pathology revealed 7 endometriomas, 3 mucinous cystadenomas, 3 serous cystadenomas, 3 serous cysts, and 3 teratomas. Direct trocar insertion within the ovarian cyst followed by aspiration of the fluid contents is a safe and feasible method for the laparoscopic management of large ovarian cysts.

A Case of Giant Ovarian Cyst Managed Successfully Through Laparoscopic Surgery

Mucinous ovarian tumors account for 15% all ovarian neoplasms, of which giant variants rarely occur. Recently huge ovarian cysts (more than 12 kg) are now rarely seen because of the development in health care systems and education. The patient is 26-yearold nulligravida female who presented with abdominal distension. A laparoscopic left salpingo-oophorectomy was performed. Laparoscopic approach to giant ovarian cyst may be difficult regarding the risk of cyst rupture and limited working space. To reduce the limitations of the laparoscopy, we performed laparoscopy after aspirating the cystic contents. During laparoscopy, abdominal cavity was explored by the scope. Cyst contained about 53 L of fluid. The histopathologic examination revealed a borderline mucinous tumor of the left ovary. Laparoscopic excision of giant ovarian cyst seems to be safe and applicable treatment modality.

Renal Autotransplantation for Iatrogenic High-Grade Ureteric Stricture

A 47-year-old Hispanic woman developed a chronically obstructed left kidney, due to a long-segment ureteric stricture deemed not amenable to reimplantation, following left ovarian cyst excision in 2004. Therefore, a ureteral stent requiring exchange every 3 months was necessary, due to hydronephrosis, recurrent urosepsis, chronic pain, and a poor quality of life. Her medical history was complicated by hypertension, poorly controlled diabetes mellitus, and microalbuminuria, suggesting early diabetic nephropathy. A left nephrectomy was recommended. This was deferred, due to concern for progressive kidney failure associated with her comorbidities. A radionuclide Tc-99m MAG3 renal scan revealed differential perfusion as follows: 44% left kidney and 56% right kidney, with symmetrical uptake on the renogram phase and delayed excretion on the left, which were correctted following furosemide administration. A left ureteronephrectomy with autotransplantation of the left kidney and ureteroneocystostomy was performed in 2009. Since then, the patient has experienced no further complications or need for invasive procedures, with excellent diabetic control and stable renal function (eGFR > 60 mL/min/1.73 m2). This technique is seldom employed in the surgical management of complex ureteral injuries, but may be an alternative for appropriate cases.

Efficacy of laparoscopic stripping for ovarian cysts: Histological and clinical findings

The aim of our study was to evaluate the efficacy of the laparoscopic stripping technique on benign ovarian masses with respect to healthy ovarian tissue. Seventy-six patients between 14 and 40 years of age were enrolled after receiving a diagnosis of mono-lateral ovarian cyst and underwent laparoscopic surgery for cyst excision with the stripping technique. Histological observations of these specimens were then performed and graded on a semiquantitative scale. The 76 samples included 36 endometriotic cysts, 18 dermoid cysts, 12 serous cysts, and 10 mucinous cysts. Only 26 of the endometriomas showed histological evidence of healthy ovarian tissue that, however, differed morphologically from normal ovarian tissue. The laparoscopic stripping technique used for the excision of different ovarian cysts is a practice that safeguards the organ.

Vaporization of ovarian endometrioma using plasma energy: histologic findings of a pilot study

In ten ovarian endometriomas of diameter exceeding 30 mm, managed by complete vaporization of the inner surface using plasma energy followed by cystectomy, we performed histologic evaluation of the depth of necrosis and the effectiveness of endometrial tissue ablation. We observed that plasma energy allows the ablation of endometrial tissue with minimal damage to the ovarian parenchyma, which suggests that this technique might be of particular interest for women with risk factors of postoperative ovarian reserve impairment, such as recurrent and bilateral endometriomas.

Comparing Ovarian Reserves After Laparoscopic Excision of Ovarian Endometriotic Cysts and Ovarian Nonendometriotic Cysts

Abstract Objective: This study compared ovarian response to controlled ovarian hyperstimulation between women who previously underwent laparoscopic excision of an ovarian endometriotic monolateral cyst with women who had surgery for ovarian nonendometritoic monolateral cysts. Materials and methods: This was a retrospective review of women who underwent controlled ovarian hyperstimulation for in vitro fertilization or intracytoplasmicsperm injection after laparoscopic excision of an ovarian endometriotic monolateral cyst (group A) after surgery for ovarian nonendometritoic monolateral cysts (group B). The contralateral intact ovary and the operated ovary of each patient were compared in terms of the number of follicles with a mean diameter gt;15 mm at the time of human chorionic gonadotropin administration between groups A and B. An unpaired Student's t-test was used to investigate differences between groups A and B. Results: Thirteen (13) and 7 women were recruited for groups A and B. Although the mean (±...

Robot‐Assisted Pediatric Surgery: How Far Can We Go?

The purpose of this study was to assess the safety and feasibility of performing robot-assisted pediatric surgery using the da Vinci Surgical System in a variety of surgical procedures. A retrospective review of 144 robot-assisted pediatric surgical procedures performed in our institution between June 2004 and December 2007 was done. The procedures included the following: 39 fundoplications; 34 cholecystectomies; 25 gastric bandings; 13 splenectomies; 4 anorectal pull-through operations for imperforate anus; 4 nephrectomies; 4 appendectomies; 4 sympathectomies; 3 choledochal cyst excisions with hepaticojejunostomies; 3 inguinal hernia repairs; two each of the following: liver cyst excision, repair of congenital diaphragmatic hernia, Heller's myotomy, and ovarian cyst excision; and one each of the following: duodeno-duodenostomy, adrenalectomy, and hysterectomy. A total of 134 procedures were successfully completed without conversion; 7 additional cases were converted to open surgery, and 3 were converted to laparoscopic surgery. There were no system failures (e.g., setup joint, arm, or camera malfunction; power error; monocular or binocular loss; metal fatigue or break of surgeon's console hand piece; software incompatibility). There was one esophageal perforation and two cases of transient dysphagia following Nissen fundoplication. The mean patient age was 8.9 years, and the mean patient weight was 57 kg. Robot-assisted surgery appears to be safe and feasible for a number of pediatric surgical procedures. Further system improvement and randomized studies are required to evaluate the benefits, if any, and the long-term outcomes of robotic surgery.

Laparoscopic management of giant ovarian cysts in adolescents.

A laparoscopic approach to giant ovarian cysts in girls, when the cyst's size exceeds the umbilicus, may be difficult regarding the risk of cyst rupture and limited working space. We present a series of three 12-year-old girls with giant ovarian cysts treated by percutaneous drainage under ultrasonographic guidance followed by laparoscopic resection. Clinical, laboratory and radiological diagnosis showed no signs of malignancy. After induction of general endotracheal anaesthesia, under ultrasonographic guidance, a 10 F vesicostomy catheter was placed into the cyst. Two to 4 l of serous (in one case mucinous) fluid were drained from the cyst. During laparoscopy, the abdominal cavity was inspected by the scope and no signs of malignancy were found. The laparoscopic procedure was completed with excision of the cyst and keeping some ovarian tissue in all cases. No intraoperative complications were observed. The mean operation time was 73 min. Pathological examination revealed a mature cystic teratoma in two cases and mucinous cystadenoma in one. The postoperative recovery was uneventful in all girls and they were discharged home on postoperative day 2-4 with minimal pain. The ultrasound scans and tumour markers were normal on follow-up after 3 and 6 months. Laparoscopic excision of giant ovarian cysts after ultrasound-guided drainage seems to be a safe and applicable treatment modality in pre-menarchal girls with a normal tumour marker profile and benign features of the cyst, excluding the possibility of malignancy.