Surgical Treatment Of Ovarian Cysts Research Articles

Laparoscopic guided minilaparotomy: a modified technique for management of benign large ovarian cysts

BackgroundThe aim of the study is to evaluate the efficiency and safety of a novel technique to treat large benign ovarian cysts combining benefits of laparoscopic management along with mini-laparotomy without affection of the ovarian reserve.MethodsThe study included 112 women with large benign ovarian cyst candidate for ovarian cystectomy. The technique started with laparoscopy followed by guided cyst aspiration followed by exteriorization of the ovary through minilaprotomy and completion of cystectomy through microsurgical technique. The primary outcome was ipsilateral recurrence of the cyst. Other outcomes included ovarian reserve assessment and postoperative pain.ResultsThe number of women with recurrence in the ipsilateral ovary after 12, 18 and 24 months were 5 (4.5%),16 (14.3%),20 (17.85%) respectively. Assessment of ovarian reserve revealed a significant decrease in the level of serum AMH (2.82 ± 0.44 vs. 2.50 ± 0.42) and a significant increase in AFC (3.5 ± 1.7 vs. 4.9 ± 1.3) after our novel technique in surgical treatment of ovarian cysts (P value < 0.001). The operative time was 50 ± 7 and 62 ± 7 min in unilateral and bilateral cysts respectively.ConclusionsLaparoscopic guided minilaparotomy is a safe and effective technique for the management of large benign ovarian cysts with minimal recurrence rate, ovarian reserve affection and adhesions.Trial registration: clinical trial registry no. NCT03370952. Registered 13 December 2017,https://clinicaltrials.gov/ct2/show/NCT03370952

Abdominal pain syndrome in girls, adolescents and young women with tumor-like formations of the uterine adnexa

The article presents the clinical features of the complicated course of tumor-like formations of the uterine adnexa in girls, adolescents and young women. The characteristic symptoms of adnexal torsion are described. Topographic and anatomic features leading to torsion of ovarian cysts and uterine appendages, features of the surgical treatment of patients with complicated adnexal torsion are presented.&#x0D; The aim was to study the frequency of occurrence of ovarian tumor-like formations and their complicated course in girls, adolescents and young women, improve early diagnosis and develop optimal methods of conserving surgical treatment of this pathology.&#x0D; Material and methods. The study included 90 girls, adolescents and young women. Patients were divided into three groups. 1 group included 30 young women; the 2nd group consisted of 35 adolescents 13-17 years; 3 group consisted of 25 girls from 2 to 12 years. Diagnostic complex included clinical, special gynecological, comprehensive laboratory, ultrasound (including doppler ultrasound) research, computer and magnetic resonance imaging (if indicated).&#x0D; Results and discussion. The final diagnosis of “Ovarian cyst” was verified in 46 of 90 patients (51,1 %): group 1 – 26 of 30 (86,6 %), in 2 – 18 of 35 (51,4 %), in 3 - 2 of 25 (8 %). It is established that the torsion of the uterine adnexa was detected in 44 of 90 patients: in 1 group – 13,3% of cases (4 of 30 young women), in 2 group – 48,5 % (17 of 35 adolescents), in 3 group – 92 % (23 of 25 girls). 76 surgeries were performed by laparoscopy with preservation of the ovarian reserve, 12 patients were treated conservatively with final diagnosis “Ovulatory syndrome” and “Retention cyst of the ovary”.&#x0D; Conclusions. Ovarian cyst as the cause of abdominal pain is significantly more often diagnosed in young reproductive age than in patients of prepubertal and pubertal age. In girls and adolescent girls with symptoms of acute abdomen the torsion of intact uterine adnexa was significantly more common than in adult patients, due to anatomical features of the internal reproductive organs and more a mobile lifestyle inherent in this age group. Optimal treatment of functional ovarian cyst is complex conservative therapy, surgical treatment of ovarian cysts at a young age is conducted under strict indications, treatment of choice is laparoscopy.

Ovarian cysts

Ovarian cysts

The feasibility of natural orifice transluminal endoscopic surgery in gynecology practice: Single-surgeon experience

Objectives:Natural orifice transluminal endoscopic surgery (NOTES) has been performed in gynecology practice for the surgical treatment of ovarian cysts, uterine fibroids, ectopic pregnancies, adnexal masses, and pelvic organ prolapse. The aim of this study is to evaluate the intraoperative and postoperative outcomes of patients who underwent NOTES for gynecological diseases.Materials and Methods:This study was a retrospective clinical study. The data of 50 patients who had been treated via NOTES procedure for benign gynecological indications such as ectopic pregnancy, adnexal mass, uterine fibroid, and treatment-resistant heavy menstrual bleeding during the time period between January 2016 and 2019 were included. All procedures were performed by a single surgeon (C.K.) using a self-constructed glove port, and a sealing device in addition to conventional laparoscopic (CL) equipment. Descriptive analysis of the patients' data was performed.Results:The initial two of the adnexectomy procedures were performed via hybrid NOTES technic and four of them were performed via total vaginal NOTES technic. The remaining procedures, namely hysterectomies, adnexectomies, salpingectomies, and myomectomy were performed via vaginally assisted NOTES (VaNOTES) technic. The mean operation time for the hysterectomy ± bilateral salpingo-oophorectomy (BSO) and salpingo-oophorectomy patients was 85.25 min and 53.15 min, respectively. For those patients who underwent VaNOTES procedure, the median postoperative visual analog scale pain score at the 6thh was six and at the 24thh was two. The mean length of the hospital stay was 2.07 days in the hysterectomy ± BSO patients and 1.63 days in the salpingo-oophorectomy patients.Conclusion:The NOTES procedure is a feasible technic in regards to the duration of surgery, postoperative pain scores, and cosmetic outcomes.

Gynecologic and reproductive outcomes in fibrous dysplasia/McCune-Albright syndrome

BackgroundAutonomous ovarian activation with recurrent estrogen-producing cysts is a hallmark feature of the rare bone and endocrine disorder fibrous dysplasia/McCune-Albright syndrome. Precocious puberty in girls with McCune-Albright syndrome has been well-described, however long-term effects on gynecologic and reproductive function are unknown. Concerningly, case reports have described poor skeletal outcomes associated with pregnancy in women with fibrous dysplasia.MethodsThirty-nine women with fibrous dysplasia/McCune-Albright syndrome were evaluated as part of a natural history study. Clinical, radiographic, and biochemical data were reviewed. Women were contacted to obtain detailed menstrual and reproductive histories.ResultsAbnormal uterine bleeding affected 77% of women (30/39), and was associated with severe anemia requiring blood transfusion in 3 cases. Nine women underwent hysterectomy for management of bleeding, including 67% (6/9) at the unusually young age of less than age 35 years. Infertility affected 43% of women (9/21), including 2 women who developed primary ovarian insufficiency after undergoing surgical treatment of ovarian cysts. Of 25 spontaneous pregnancies in 14 women, 35% (8) were unplanned. Among the 14 pregnancies, pregnancy was associated with no change in bone pain in 7 subjects (53%), increased bone pain in 4 subjects (31%), and decreased bone pain in 2 subjects (15%). No additional skeletal complications were reported during pregnancies.ConclusionsWomen with fibrous dysplasia/McCune-Albright syndrome report a high prevalence of gynecologic morbidity and reduced fertility. There is no clear association between pregnancy and poor skeletal outcomes in this population.

Effect of menstrual phase on the surgical treatment of ovarian cysts

This study aimed to determine whether the menstrual cycle affects operative bleeding and postoperative ovarian reserve in patients undergoing laparoscopic ovarian cystectomy. A total of 155 patients who had undergone laparoscopic ovarian cystectomy were classified into the follicular phase (n = 84) and luteal phase (n = 71) of the menstrual cycle. The primary outcome measures were operative blood loss and the rate of decline in ovarian reserve, as calculated by measuring serial serum anti-Müllerian hormone (AMH) levels preoperatively and 3 months postoperatively. No significant difference in the baseline demographics, operative blood loss (p = .984), the rate of decline in ovarian reserve (p = .945), and other surgical outcomes were observed between both the groups. These results demonstrate that the menstrual cycle had no influence on the operative blood loss and ovarian reserve during laparoscopic ovarian cystectomy. Therefore, the menstrual cycle is not an important factor to determine the optimal timing of ovarian cystectomy.Impact statementWhat is already known on this subject?: The menstrual cycle results in periodic changes in haemostasis and blood flow in the reproductive organs.What do the results of this study add?: These results demonstrate that the menstrual cycle had no influence on the operative blood loss and ovarian reserve during laparoscopic ovarian cystectomy.What are the implications of these findings for clinical practice and/or further research?: The menstrual cycle is not an important factor to determine the optimal timing of ovarian cystectomy.

Diagnosis and management of organic ovarian cysts: indications and procedures for laparoscopy

In the field of gynaecological surgery, the past few years have been significant due to the development of operative laparoscopy. Originally recommended for the diagnosis of female infertility, over the past 15 years laparoscopy has acquired the standing of a surgical discipline in its own right. Laparoscopic surgical treatment of ovarian cysts, whether conservative or radical, has now been completely standardized. The aim of this work is to specify the indications, procedures and risks involved with this surgery as applied to organic ovarian cysts. Only benign ovarian cysts are suitable for treatment by laparoscopic surgery; ovarian cancer must always be handled by classic surgery using a mid-line laparotomy. Given that clinical and other pre-operative investigations can give only an indication, ovarian lesions require surgical investigation to diagnose the histological type. Laparoscopy appears to be as reliable as laparotomy when assessing whether an ovarian tumour is malignant. The risk of parietal contamination and peritoneal dissemination if a malignancy is not recognized means that, if there are no signs of extra-ovarian extension, adnexectomy is mandatory whenever there is the slightest doubt. This adnexectomy must obey two important rules: it must be accomplished without rupturing the cyst, and the cyst must be placed, intact, inside an endoscopic bag before being extracted. Provided that all stages of the procedure, from pre-operative work-up to the initial diagnostic phase of the laparoscopy, are carried out meticulously, laparoscopic surgery is reliable for both the diagnosis and the management of benign organic-ovarian cysts.

Cancer and the Ovary

This Presidents Address gives a brief history of the surgical treatment of ovarian cysts and the problems of all cancers are then discussed followed by special reference to ovarian cancers. The immunological defenses of the body to cancer are recognized and the adverse effects of x-ray and some drug therapy on these defenses considered. Recent virus studies have shown that all the viruses involved in transmitting tumors are similar in appearance and genetic structure; all have a long single-stranded molecule of ribonucleic acid. They are known as oncorna viruses and their receptors are very specific even within a given species. Chemical carcinogens may act on cells by being transformed into noxous substances by tissue enzymes; such changes are inherited by future generations of cells after the original carcinogen no longer operates. The most rewarding studies in the future are predicted to be in the immunology chemical oncology and virology areas. Ovarian cancer is often not diagnosed until too late for curative surgery. Abdominal pain and swelling are the most common early symptoms. Postmenopausal bleeding can also occur early in the disease. Laparoscopy is the preferred method of early diagnosis. Ovarian cancer most frequently spreads from the ovarian surface to adjacent structures. Ascites usually indicate dissemination. Cyst rupture at operation justifies additional therapy but may not be as serious as regarded by some. In determining results standardization of histology grading and staging are needed. The stage present at operation is the most important. Radical surgery has been advocated even when the growth is limited to the ovary; however others have found that removing only the diseased ovary in Stage 1 produces equally favorable results. As only about 65% of good risk cases survive 5 years adjuvant therapy is indicated. With surgery and radiotherapy Stage 2 mean survival is 40%; in later stages only 5% have 5-year survival. Chemotherapy has been reported by some as better than radiotherapy. Alkylating agents administered orally or iv seem best. The sensitivity testing of cancer cells is a most optimistic approach and is the best reason for setting up a Central Ovarian Cancer Registry.