Management Of Large Ovarian Cysts Research Articles

8219 Laparoscopic Access in Patients with Large Ovarian Cysts

<h3>Study Objective</h3> Minimally invasive approaches are preferred in the surgical management of large ovarian cysts but gaining abdominal access can pose significant challenges for the gynecologic surgeon. Our objective is to review abdominal entry options in women with large ovarian cysts and demonstrate an approach we have successfully used in a recent case at our institution. <h3>Design</h3> N/A. <h3>Setting</h3> OR. <h3>Patients or Participants</h3> 87-year-old G0 female with 20 cm left ovarian cyst, palpated above the umbilicus. <h3>Interventions</h3> laparoscopic LSO for 20 cm ovarian cyst using mini-laparotomy and protector-retractor system for abdominal access. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> Combining a mini-laparotomy at the umbilicus using a protector-retractor system allows the gynecologic surgeon to complete most of the procedure laparoscopically. This approach also allows for extra-peritoneal drainage of cyst contents, thereby minimizing intra-peritoneal spillage, as well as for easy specimen removal.

Ovarian Cysts Management Following Laparoscopic Surgery

Objective: To analyze diagnostic and surgical outcomes in patients with extremely large ovarian cysts treated by laparoscopic surgery.&#x0D; Methods: A total of 120 cases of large adnexal masses and suspected for malignancy were treated laparoscopically at the at general surgery department of Liaquat University of Medical &amp; Health Sciences. Under endotracheal anesthesia, all surgeries were performed using nasogastric tubes in the stomach. An incision of approximately 1.5 centimeter was made at the supraumbilical or umbilical region and peritoneal cavity was approached. The intra-abdominal approach in all cases was cautiously standardized. The resection of the adnexal mass was performed as per routine method.&#x0D; Results: 12 females were premenopausal and 8 were postmenopausal. 12 women presented with the signs of urinary retention, urinary urgency and abdominal pain. Incidental sonography detected cysts in 8 patients which were asymptomatic. The average volume of the resected cystic fluid was 3000ml (range 900 to 9000 ml). The specimens of frozen section were obtained within the surgical procedure in all patients except 2 patients having para-ovarian cysts. The histopathology presented mucinous benign cystadenoma. There was no blood loss and related other complications reported in all operations.&#x0D; Conclusion: Laparoscopic management of large ovarian cyst observed to a effective, feasible and less complicated surgical option. However accurate selection and diagnosis of the patients, the any ovarian cyst size can be treated easily via laparoscopic surgery.

Laproscopic Management of Large Ovarian Cyst with Pregnancy: A Case Report

Background: Before a pregnant woman's baby birth, the incidence of cyst is the most common. Due to availability of quality antenatal ultrasound, ovarian cysts in the pregnant woman are diagnosed more frequently. The large (&gt;5 cm) and complex cysts are symptomatic and it required to be managed by surgical intervention. Cyst might rupture, twist, or even cause problems during childbirth.&#x0D; Aims and objective: To bring relief to a primigravida with 16 weeks pregnancy after spontaneous conception, presented with complain of hugely distended abdomen with marked discomfort and to preserve her pregnancy.&#x0D; Case Report:&#x0D; Materials and Methods: A 26 year old pregnant woman with ovarian cyst was enrolled and treated through laparoscopic management.&#x0D; Results: After the laparoscopic removal of cyst the post-operative period of the pregnant woman was found uneventful. The pregnancy of the woman was progressed smoothly and there was no any complications during the pregnancy. Full term normal delivery (FTNVD) was occurred and the baby was healthy with weight of approximately 2.55 Kgs.&#x0D; Conclusion: Large ovarian cyst can be managed without disturbing the pregnancy and a complicated case can be transformed into a normal ante natal check-ups (ANC).

Large ovarian cysts assumed to be benign treated via laparoscopy

The aim of this study was to assess the feasibility and outcome of laparoscopic surgery in the management of large ovarian cysts in patients treated at a university hospital. Twelve patients with large (diameter >10 cm) ovarian cysts were managed laparoscopically from November 2009 to July 2014. The cystic masses were not associated with ascites or enlarged lymph nodes on ultrasound. Serum CA-125 levels were within the normal range (35 U/ml). Preoperative evaluation included history, clinical examination, sonographic images, and serum markers. The management of these ovarian cysts included aspiration, cystectomy, or salpingo-oophorectomy, depending on the patient’s age, obstetric history, and desire for future fertility. Five patients presented with abdominal pain and two with abdominal distension and discomfort. In the five patients, the cyst was an incidental finding on a routine review. The average maximum diameter of the ovarian cysts was 25 cm (range 13–41 cm). The mean duration of the operation was 87 min. The postoperative hospital stay was 1–4 days. No intraoperative complications occurred, and the hospital course of all patients was uncomplicated. In no case was laparoscopy converted to laparotomy. With proper patient selection, the size of an ovarian cyst is not necessarily a contraindication for laparoscopic surgery.

Single-Port (Octoport) Assisted Extracorporeal Ovarian Cystectomy for the Treatment of Large Ovarian Cysts: Compare to Conventional Laparoscopy and Laparotomy

Study ObjectiveTo evaluate single-port assisted extracorporeal cystectomy for treatment of large ovarian cysts and to compare its surgical outcomes, complications, and cystic content spillage rates with those of conventional laparoscopy and laparotomy. DesignRetrospective study (Canadian Task Force classification II-2). SettingUniversity teaching hospital. PatientsTwenty-five patients who underwent single-port assisted extracorporeal cystectomy (group 1), 33 patients who underwent conventional laparoscopy (group 2), and 25 patients who underwent laparotomy (group 3). InterventionsSurgical outcomes, complications, and spillage rates in group 1 were compared with those in groups 2 and 3. Measurements and Main ResultsPatients characteristics and tumor histologic findings were similar in the 3 groups. The mean (SD) largest diameter of ovarian cysts was 11.4 (4.2) cm in group 1, 9.7 (2.3) cm in group 2, and 12.0 (3.4) cm in group 3. Operative time in groups 1 and 2 was similar at 69.3 (26.3) minutes vs 73.1 (36.3) minutes (p = .66); however, operative time in group 1 was shorter than in group 3, at 69.3 (26.3) minutes vs 87.5 (26.6) minutes (p =.02). Blood loss in group 1 was significantly lower than in groups 2 and 3, at 16.0 (19.4) mL vs 36.1 (20.7) mL (p < .001) and 16.0 (19.4) mL vs 42.2 (39.7) mL (p = .005). The spillage rate in group 1 was profoundly lower than in group 2, at 8.0% vs 69.7% (p < .001). ConclusionSingle-port assisted extracorporeal cystectomy offers an alternative to conventional laparoscopy and laparotomy for management of large ovarian cysts, with comparable surgical outcomes. Furthermore, cyst content spillage rate in single-port assisted extracorporeal cystectomy was remarkably lower than that in conventional laparoscopy.

Laparoscopic Management of Large Ovarian Cysts

ABSTRACT Introduction Large ovarian cysts are conventionally managed by laparotomy. This study was undertaken to assess the feasibility and outcome of laparoscopic surgery for the management of large ovarian cysts. Settings and design Rural teaching hospital – prospective study. Materials and methods Thirty-eight patients from January 2014 to December 2016 presumed to be with large ovarian cyst were managed laparoscopically. Preliminary evaluation suggestive to be of benign ovarian cyst by history, clinical examination, sonographic imaging, and basic serum marker were only included in this study. The cysts were aspirated initially, followed by cystectomy, oophorectomy, or total hysterectomy depending on age, parity, coexisting pathology, and desire for future fertility. Results Out of 38 cases, 6 were nonovarian adnexal masses. Eight of the 32 cases who presented with pain due to torsion were managed on emergency basis; rest of the cases were operated electively. Mean operating time was 90 minutes. Mean size of the cyst was 16 cm. One case of borderline malignancy was detected and the rest showed benign pathology. Six of the cases required minilaparotomy for specimen removal. Most women were successfully treated laparoscopically without any complications, and conversion to laparotomy was required in three cases. Conclusion With proper patient selection and exclusion of malignancy, laparoscopic management of large ovarian cyst by gynecologist is feasible. How to cite this article Beeresh CS, Doopadapalli D, Vimala KR, Lingegowda K. Laparoscopic Management of Large Ovarian Cysts. Int J Gynecol Endsc 2017;1(1):18-21.

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.

The laparoscopic management of large ovarian cysts

To assess the laparoscopic management of large benign ovarian cysts as opposed to laparotomy. One hundred and thirty two women with ovarian cysts larger than 18 weeks pregnancy were managed laparoscopically. Five of these were borderline tumors. The cysts were aspirated laparoscopically and removed from the abdomen either by direct extraction, cutting into strips, electric morcellation or extraction through the posterior vaginal fornix. All the women were successfully treated and there were no complications. There were five borderline tumors and no frank malignancy. Follow up for 4 years revealed no malignancy. It is recommended that this is a satisfactory method of managing large benign cysts in carefully selected cases. However the exclusion of malignancy is mandatory.

Laparoscopic management of large ovarian cysts at a rural hospital

Objective:To assess the feasibility and outcome of laparoscopic surgery for the management of large ovarian cysts at a rural hospital.Materials and Methods:Fifteen patients from March 2004 to February 2007, with large ovarian cysts, with diameter >10 cm, were managed laparoscopically. The masses were cystic and were not associated with ascites or enlarged lymph nodes on ultrasound. Serum CA-125 levels were within the normal range (35 U/ml). Preoperative evaluation included history, clinical examination, sonographic images and serum markers. The management of these ovarian cysts included aspiration, cystectomy or salphingo-oophorectomy, depending on the patient’s age, obstetric history and desire of future fertility. In large, solid, fixed or irregular adnexal masses, suspicious of malignancy, laparotomy was done.Results:Five patients presented with pain in the abdomen and 10 patients with abdominal distension and discomfort. The average maximum diameter of the ovarian cysts was 16.75 cm (range 10–24 cm). The mean duration of the operation was 80 min. The postoperative hospital stay was from 4 to 6 days. No intraoperative complications occurred and the hospital course of all patients was uncomplicated. In one case, laparoscopy was converted to laparotomy. One patient had minor wound infection at umbilical port site. The patients did not report any complaints during follow up and the clinical examination findings were normal in all, up to 9 months after discharge.Conclusion:With proper patient selection, the size of an ovarian cyst is not necessarily a contraindication for laparoscopic surgery.

Minimal access approach to the management of large ovarian cysts

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.

Minimal access approach to the management of large ovarian cysts

Laparoscopy has become an accepted method of management for ovarian cysts. Large ovarian cysts, however, have traditionally been, and continue to be treated by laparotomy. This is mainly due to technical difficulties and the possibility of malignancy. We describe four patients in whom laparoscopy was used to remove large ovarian cysts. Laparoscopic guided aspiration was performed, followed by extra-abdominal excision of the cyst. This approach has the advantages of minimising the risk of spillage of cyst fluid, a smaller incision compared to laparotomy, as well as faster recovery. We advocate this method for large unilocular benign cysts.

TIPS &amp; TRICKS 1: A Novel Technique for the Minimally Invasive Management of Large Ovarian Cysts

TIPS &amp; TRICKS 1: A Novel Technique for the Minimally Invasive Management of Large Ovarian Cysts

Laparoscopic excision of large ovarian cysts.

The aim of this study was to check the ability of operative laparoscopy to help in the management of large ovarian cysts that may reach above the level of the umbilicus. Fifteen cases of large ovarian cysts reaching above the level of the umbilicus were chosen. Clinical and ultrasonic diagnosis denied any signs of malignancy. Pneumoperitoneum and a 5 mm trocar were inserted safely in the left midclavicular line below the ninth costal margin. This trocar allowed us to inspect the peritoneal cavity thoroughly. Another 5 mm trocar was inserted suprapubically in the contralateral side of the cyst and better inspection of the cyst and peritoneal cavity was then done. In the case of an apparently benign cyst, aspiration of the cyst fluid was done after puncturing its wall, then the cyst was removed as usual. In all of these cases, there was no laparoconversion and no other complications were recorded. Nine cases were mucinous and six were serous cystadenomas. The mean operation time was 53.66 +/- 14.7 min. Laparoscopic excision of large ovarian cysts is possible, and safe in suitable conditions, with immediate laparoconversion at hand at any time.