Laparoscopic Removal Of Ovarian Cysts Research Articles

Acute postoperative pain in 23 procedures of gynaecological surgery analysed in a prospective open registry study on risk factors and consequences for the patient

Effective perioperative pain management is essential for optimal patient recovery after surgery and reduces the risk of chronification. However, in clinical practice, perioperative analgesic treatment still needs to be improved and data availability for evidence-based procedure specific analgesic recommendations is insufficient. We aimed to identify procedures related with high pain scores, to evaluate the effect of higher pain intensity on patients and to define patient and intervention related risk factors for increased pain after standard gynaecological and obstetrical surgery. Therefore, we performed a prospective cross-sectional study based on the German registry for quality in postoperative pain (QUIPS). A cohort of 2508 patients receiving surgery between January 2011 and February 2016 in our tertiary referral centre (university departments of gynaecology and obstetrics, respectively) answered a validated pain questionnaire on the first postoperative day. Maximal pain intensity was measured by means of a 11-point numeric rating scale (NRS) and related to procedure, perioperative care as well as patient characteristics. The interventions with the highest reported pain scores were laparoscopic removal of ovarian cysts (NRS of 6.41 ± 2.12) and caesarean section (NRS of 6.98 ± 2.08). Factors associated with higher pain intensity were younger age (OR 1.75, 95% CI 1.65–1.99), chronic pain (OR 2.08, 95% CI 1.65–2.64) and surgery performed outside the regular day shift (OR 1.67, 95% CI 1.09–2.36). Shorter duration of surgery, peridural or local analgesic and preoperative sedation reduced postoperative pain. Patients reporting high pain scores (NRS ≥ 5) showed relevant impairment of daily activities and reduced satisfaction. Caesarean section and minimal invasive procedures were associated with the highest pain scores in the present ranking. Pain management of these procedures has to be reconsidered. Younger age, receiving surgery outside of the regular shifts, chronic pain and the surgical approach itself have a relevant influence on postoperative pain intensity. When reporting pain scores of 5 or more, patients were more likely to have perioperative complications like nausea or vomiting and to be impaired in mobilisation. Registry-based data are useful to identify patients, procedures and critical situations in daily clinical routine, which increase the risk for elevated post-intervention pain. Furthermore, it provides a database for evaluation of new pain management strategies.

Short- and long-term outcomes of intraoperative spillage during laparoscopic removal of benign ovarian cysts.

To compare the short- and long-term outcomes in patients with and without intraoperative spillage from benign adnexal masses during laparoscopic removal. We conducted a retrospective analysis of all cases of laparoscopic removal of ovarian cysts (cystectomy or adnexectomy) in our institution between the years 2013 and 2017, excluding malignant lesions. During the study period, 186 cases of ovarian cyst removal were identified. Intraoperative ovarian cyst spillage (IOCS) occurred in 104 cases (study group), while in the remaining 82 cases no spillage was reported (control group). Baseline clinical characteristics were comparable between groups. Large cyst diameter and intraperitoneal adhesions were significantly associated with the occurrence of IOCS (P = 0.008 and< 0.001, respectively). The use of an endoscopic retrieval bag was significantly inversely associated with IOCS. Postoperative complications (pain score, hospital stay, febrile illness and recurrence of ovarian cyst) were comparable between groups. IOCS during laparoscopic cystectomy is associated with larger cyst diameter and intraperitoneal adhesions, but not with adverse short- or long-term outcomes nor with recurrence rates.

The impact of laparoscopic ovarian cystectomy on ovarian reserve as assessed by antral follicle count and serum AMH levels

OBJECTIVE: Laparoscopic excision of ovarian cysts particularly endometrioma and dermoid cysts are commonly performed in women of reproductive age. We aimed to objectively determine if such a surgical procedure had any negative impact on ovarian reserve. DESIGN: A prospective study. MATERIALS AND METHODS: Of 16 patients (mean age ± [SE] 29.5 ± 1.9) enrolled in the study 12 had unilateral, one had bilateral endometriomas, and 3 had unilateral dermoid cysts. Ovarian reserve was determined with antral follicle count (AFC) and serum antimullerian hormone (AMH) levels measured before and one month postoperatively. Removed cysts were histologically examined for the presence of ovarian cortex and the follicles. RESULTS: The duration of the operation (mean age ± [SE]) was 44.7 ± 3.6 minutes. The mean cyst diameter was 52.5 ± 5.4 mm for endometriomas and 58.1 ± 8.5 mm for dermoid cysts. The cysts were removed completely in all patients. Pre and postoperative AFCs were similar (6.4 ± 0.6 vs. 6.7 ± 0.6 p>0.05, respectively). Serum AMH levels declined postoperatively, however, the difference was not statistically significant (3.7 ± 0.5 vs. 2.7 ± 0.4 p>0.05). Preoperative AMH levels were positively correlated with AFC (r=0.50, p<0.05) but this correlation was lost postoperatively (r=0.46, p>0.05). Both AMH and AFC were negatively correlated with age (r=-0.59 p<0.05, r=-0.61 p<0.05, respectively). On histological examination one antral follicle in one section from a patient and some clusters of primordial follicles in the others did not cause any significant decline in AMH levels postoperatively. CONCLUSIONS: Our results indicate that laparoscopic removal of ovarian cysts using a standard atraumatic technique does not adversely affect the AFC. AMH levels decreased postoperatively but the difference did not reach statistical significance, perhaps due to the small number of patients in the study. The impact of cystectomy on ovarian reserve should be assessed objectively in larger number of patients in order to reach definitive conclusions.

Laparoscopic removal of adnexal cysts: is it possible to decrease inadvertent intraoperative rupture rate?

The objective of the study was to characterize surgical risks for intraoperative rupture of benign adnexal lesions during laparoscopy. We conducted a retrospective review of cases of laparoscopic removal of ovarian cysts (adnexectomy or cystectomy) in our institution from 2002-2006, excluding procedures in which cysts were intentionally ruptured. There were 256 operations (263 ovarian cysts). The patients' mean age was 40.9 +/- 15.8 years. The overall rate of inadvertent intraoperative rupture of cyst was 16.6% (adnexectomies 7.4% and conservative cystectomies 29.5%; P < .001). There was no significant correlation between inadvertent intraoperative rupture and adnexal torsion, pelvic adhesions, bilateral adnexal surgery, concomitant uterine surgery, presence of pelvic endometriotic foci, pregnancy, and surgeons' experience. Only cyst size and cystectomy procedure were positively and significantly associated with inadvertent cyst rupture (multivariate regression analysis). Inadvertent intralaparoscopic rupture of adnexal cyst is significantly associated with cystectomies of large ovarian cysts for which laparotomy or laparoscopic-assisted extracorporeal cystectomy should be considered.

Ovarian recovery after laparoscopic removal of ovarian cysts: Insights from short-term postsurgical follow-up

Ovarian recovery after laparoscopic removal of ovarian cysts: Insights from short-term postsurgical follow-up

Role of Surgery in Ovarian Cancer: An Update

Rupture of an ovarian malignant tumor should be avoided at the time of surgery for an early ovarian cancer. Laparoscopic removal of ovarian cysts should be restricted to patients with preoperative evidence that the cyst is benign. Degree of differentiation is the most important independent prognostic factor in stage I disease and should be used in decisions on therapy in clinical practice and the future FIGO-classification of Stage I. In early ovarian cancer staging adequacy and tumor grade were the only 2 statistical significant prognostic factors for survival in the multivariate analysis of the EORTC ACTION-trial. According to the present data there is no scientific basis to rely only on adjuvant chemotherapy or on optimal staging procedure in medium and high risk stage I ovarian cancer. Primary debulking surgery by a gynecologic oncologist remains the standard of care in advanced ovarian cancer. Optimal debulking surgery should be defined as no residual tumor load. Interval debulking is defined as an operation performed after a short course of induction chemotherapy, usually 2 or 3 cycles. Based on the randomized EORTC-GCG trial, interval debulking by an experienced surgeon improves survival in some patients who did not undergo optimal primary debulking surgery. Based on the GOG 152 data, interval debulking surgery does not seem to be indicated in patients who underwent primarily a maximal surgical effort by a gynecological oncologist. Open laparoscopy is probably the most valuable tool for evaluating the operability primarily or at the time of interval debulking surgery. In retrospective analyses neoadjuvant chemotherapy followed by interval debulking surgery does not seem to worsen prognosis compared to primary debulking surgery followed by chemotherapy. However, we will have to wait for the results of the EORTC-GCG/NCI Canada randomized trial to know whether neoadjuvant chemotherapy followed by interval debulking surgery is as good as primary debulking surgery in some or all stage IIIc and IV patients. The most suitable candidates for secondary debulking surgery are those who had an initial complete response to chemotherapy, a long treatment-free interval (e.g. more than 12 months), and resectable disease (without diffuse carcinomatosis).

Controversies in surgery in ovarian cancer — what is its real role?

Rupture of an ovarian malignant tumour should be avoided at the time of surgery for an early ovarian cancer. Laparoscopic removal of ovarian cysts should be restricted to patients with preoperative evidence that the cyst is benign. Degree of differentiation is the most important independent prognostic factor in stage I disease and should be used in decisions on therapy in clinical practice and the future FIGO (International Federation of Gynecology and Obstetrics) classification of stage 1. In early ovarian cancer, staging adequacy and tumour grade were the only two statistically significant prognostic factors for survival in the multivariate analysis of the EORTC (European Organisation for Research and Treatment of Cancer) ACTION (Adjuvant ChemoTherapy In Ovarian Neoplasms) trial. According to the present data there is no scientific basis to rely only on adjuvant chemotherapy or on optimal staging procedure in medium and high risk stage I ovarian cancer. Primary debulking surgery by a gynaecological oncologist remains the standard of care in advanced ovarian cancer. Optimal debulking surgery should be defined as no residual tumour load. Interval debulking is defined as an operation performed after a short course of induction chemotherapy, usually 2 or 3 cycles. Based on the randomised EORTC GCG (Gynaecological Cancer Group) trial, interval debulking by an experienced surgeon improves survival in some patients who did not undergo optimal primary debulking surgery. Based on the GOG (Gynecologic Oncology Group) 152 data, interval debulking surgery does not seem to be indicated in patients who underwent primarily a maximal surgical effort by a gynaecological oncologist. Open laparoscopy is probably the most valuable tool for evaluating the operability primarily or at the time of interval debulking surgery. In retrospective analyses, neoadjuvant chemotherapy followed by interval debulking surgery does not seem to worsen prognosis compared to primary debulking surgery followed by chemotherapy. However, we will have to wait for the results of the EORTC-GCG/NCI (National Cancer Institute) Canada randomised trial to know whether neoadjuvant chemotherapy followed by interval debulking surgery is as good as primary debulking surgery in some or all stage IIIc and IV patients. The most suitable candidates for secondary debulking surgery are those who had an initial complete response to chemotherapy, a long treatment-free interval (e.g. more than 12 months), and resectable disease (without diffuse carcinomatosis).

Laparoscopic removal of ovarian cysts during pregnancy

Twelve women underwent laparoscopic removal of benign ovarian cysts during pregnancy. Gestational age at the time of surgery ranged from 12 to 20 weeks (mean 15 wks). Cyst size ranged from 6 to 9 cm (mean 7.1 cm). In all 12 patients a cystectomy was performed. Estimated blood loss ranged from 30 to 90 ml, operating time from 20 to 70 minutes (mean 48 min), and hospital stay from 1 to 3 days. No intraoperative complications occurred. All the women delivered at term without incident and none required a cesarean section. Laparoscopic cystectomy proved to be a safe operation during first and second trimesters of pregnancy.

Laparoscopic removal of ovarian cysts using a zipper storage bag.

Laparoscopic surgery has become increasingly popular in the management of pelvic masses. A major problem during laparoscopic surgery is removal of the specimen. The advantages of the bag retrieval technique using commercially available retrieval bag has been described. However, the size of the bags available is limited and they are relatively expensive. We describe the use of a zipper storage bag for the removal of ovarian cysts in 11 patients undergoing operative laparoscopy without spillage of the cyst contents, the need for abdominal wound extension or to perform a culdotomy. The operating time is reduced, compared to 'purpose designed' bag retrieval systems. This technique is safe, easy to perform and cost-effective.

The cost-effectiveness of 10 selected applications in minimally invasive therapy

In this article, evidence of effectiveness and cost-effectiveness of the following procedures is reviewed: (1) laser treatment of bladder tumors; (2) extracorporeal shock-wave lithotripsy and percutaneous nephrolithotomy; (3) laparoscopic treatment of endometriosis; (4) laparoscopic removal of ovarian cysts; (5) laparoscopic cholecystectomy; (6) laparoscopic appendectomy; (7) catheter treatment of coronary artery disease; (8) palliation of colon cancer by endoscopic intervention; (9) treatment of upper gastrointestinal (UGI) bleeding by endoscopic intervention; and (10) arthroscopic knee surgery. Despite considerable potential to be effective and cost-effective, evidence is disappointingly limited in these cases. The lack of evidence hampers decision-making in this new field.