Is laparoscopic surgery safe for treating ovarian dermoid cysts. How is the procedure performed. What are the risks and benefits of laparoscopic removal of dermoid cysts. Can chemical peritonitis be prevented during laparoscopic dermoid cyst removal.

Understanding Ovarian Dermoid Cysts: Causes, Symptoms, and Diagnosis

Ovarian dermoid cysts, also known as mature teratomas, are the most common type of germ cell tumor found in women of reproductive age. These cysts contain various types of tissue derived from one or more of the three embryonic germ layers – ectoderm, mesoderm, and endoderm.

What causes ovarian dermoid cysts to form? These benign tumors develop from germ cells, which are the cells that eventually form eggs in the ovaries. For reasons not fully understood, some of these germ cells begin to develop into various tissue types, forming a cyst containing elements like skin, hair, teeth, and even thyroid tissue.

Many women with small dermoid cysts experience no symptoms. However, as the cysts grow larger, they may cause:

• Pelvic pain or pressure
• Abdominal swelling
• Changes in menstrual cycle
• Pain during intercourse
• Difficulty urinating or frequent urination

How are ovarian dermoid cysts diagnosed? The primary diagnostic tools include:

1. Pelvic examination
2. Transvaginal ultrasound
3. CT or MRI scans
4. Blood tests for tumor markers like CA-125

Ultrasound is particularly useful, as dermoid cysts often have a characteristic appearance due to their varied contents. The “tip of the iceberg” sign, where a highly echogenic nodule protrudes into the cyst cavity, is a classic ultrasound finding for dermoid cysts.

Laparoscopic Surgery for Dermoid Cysts: Technique and Advantages

Laparoscopic surgery has become the gold standard for treating ovarian dermoid cysts, offering numerous benefits over traditional open surgery. How is this minimally invasive procedure performed?

The laparoscopic technique typically involves the following steps:

1. Small incisions are made in the abdomen
2. A laparoscope (camera) and surgical instruments are inserted
3. The cyst contents are carefully aspirated to reduce its size
4. The cyst wall is dissected from the ovary
5. The specimen is removed through one of the small incisions
6. If spillage occurs, thorough irrigation is performed

Why is laparoscopy preferred for dermoid cyst removal? The advantages include:

• Shorter hospital stay
• Faster recovery time
• Less postoperative pain
• Smaller incisions and better cosmetic results
• Reduced risk of adhesions
• Quicker return to normal activities

In the study described, 63 patients with ovarian dermoid cysts underwent laparoscopic treatment. The majority (56 patients) had cystectomy performed, while 7 patients required salpingo-oophorectomy. The surgeons used 15 mm trocars for specimen removal, demonstrating that even larger dermoid cysts can be successfully managed laparoscopically.

Managing the Risk of Chemical Peritonitis During Laparoscopy

One of the primary concerns when performing laparoscopic removal of dermoid cysts is the risk of chemical peritonitis. This can occur if the contents of the cyst spill into the peritoneal cavity. How can surgeons minimize this risk?

The study highlights several important strategies:

• Careful cyst aspiration before removal
• Thorough peritoneal lavage with Ringer’s lactate solution if spillage occurs
• Placement of peritoneal drains for 24-48 hours in cases of cyst rupture

Importantly, the researchers reported no cases of chemical peritonitis among the 63 patients treated, regardless of whether cyst spillage occurred. This suggests that with proper technique and careful management, the risk of this complication can be effectively mitigated.

Histopathological Findings in Ovarian Dermoid Cysts

What do dermoid cysts look like under the microscope? The study provides interesting insights into the histopathological composition of these tumors:

• 92.63% were classified as mature dermoid cysts
• 7.37% were immature dermoid cysts
• 49% contained tissue from all three germ layers
• 40% had tissue from two germ layers
• 11% showed tissue derived from only one germ layer

This diversity in tissue composition reflects the complex nature of dermoid cysts and underscores the importance of thorough histopathological examination. While most dermoid cysts are benign, the presence of immature elements warrants close follow-up, as these have a higher risk of malignant transformation.

Preoperative Assessment and Patient Selection for Laparoscopy

Proper patient selection is crucial for ensuring the safety and success of laparoscopic dermoid cyst removal. What factors should be considered in the preoperative assessment?

• Patient age and overall health
• Size and location of the cyst
• Presence of any suspicious features on imaging
• Tumor marker levels, particularly CA-125
• Desire for future fertility

In the study, patients ranged from 20 to 54 years old, with a mean age of 37. Cyst sizes varied from 42 to 96 mm in diameter. All patients underwent preoperative transvaginal ultrasound with Doppler assessment and CA-125 testing.

These comprehensive preoperative evaluations help surgeons determine the most appropriate surgical approach and identify any potential risks or complications. For instance, very large cysts or those with features suspicious for malignancy may be better suited for laparotomy rather than laparoscopy.

Complications and Outcomes of Laparoscopic Dermoid Cyst Removal

What are the potential complications of laparoscopic dermoid cyst removal, and how common are they? The study provides encouraging data on this front:

• No intraoperative complications were reported
• No postoperative complications occurred
• No cases of chemical peritonitis were observed

These results suggest that in experienced hands, laparoscopic treatment of ovarian dermoid cysts is indeed a safe procedure. However, it’s important to note that potential complications can include:

• Bleeding
• Infection
• Damage to surrounding organs
• Ovarian tissue loss
• Rare cases of tumor dissemination (if malignant)

The study’s excellent outcomes highlight the importance of proper surgical technique, including careful cyst aspiration, thorough peritoneal lavage when needed, and appropriate use of drainage in cases of cyst rupture.

Future Directions in Minimally Invasive Treatment of Ovarian Dermoid Cysts

As surgical techniques and technology continue to advance, what might the future hold for the treatment of ovarian dermoid cysts? Several promising areas of development include:

1. Robotic-assisted laparoscopy: This technology may offer enhanced precision and visualization, potentially improving outcomes for complex cases.
2. Single-incision laparoscopic surgery (SILS): By reducing the number of incisions to just one, SILS may further minimize surgical trauma and improve cosmetic results.
3. Advanced containment systems: Development of more effective endobags or other containment devices could further reduce the risk of cyst content spillage during removal.
4. Improved imaging techniques: Enhanced preoperative imaging may allow for better surgical planning and patient selection.
5. Fertility-sparing techniques: Continued refinement of ovarian-preserving surgeries could help maintain reproductive potential in young patients.

While these advancements hold promise, it’s important to note that the fundamentals of careful surgical technique and proper patient selection will remain crucial to achieving optimal outcomes in the treatment of ovarian dermoid cysts.

Long-term Follow-up and Recurrence Risk

After successful removal of an ovarian dermoid cyst, what should patients expect in terms of long-term follow-up and risk of recurrence? While the study doesn’t provide specific long-term data, it’s important to consider these aspects of patient care:

• Regular follow-up appointments with pelvic examinations and ultrasounds
• Monitoring for any symptoms that could indicate recurrence
• Awareness of the potential for dermoid cysts to develop on the contralateral ovary
• Counseling on the impact on future fertility, if relevant

The recurrence rate for dermoid cysts after laparoscopic removal is generally low, estimated at about 3-4% in most studies. However, long-term follow-up is important to detect any recurrences early and address any concerns patients may have about their reproductive health.

Patient Education and Informed Consent

Proper patient education and informed consent are crucial components of care when considering laparoscopic treatment for ovarian dermoid cysts. What key points should be discussed with patients?

• The nature of dermoid cysts and their potential complications if left untreated
• The benefits and risks of laparoscopic surgery compared to open surgery
• The possibility of cyst rupture during the procedure and measures taken to prevent complications
• The potential impact on fertility, especially for women planning future pregnancies
• The importance of follow-up care and monitoring

By providing comprehensive information and addressing patient concerns, healthcare providers can ensure that patients are active participants in their care and are prepared for the surgical experience and recovery process.

Conclusion and Clinical Implications

The study’s findings, along with broader evidence from the field, support the conclusion that laparoscopic treatment of ovarian dermoid cysts is indeed a safe and effective procedure when performed by experienced surgeons. The low complication rates and absence of chemical peritonitis cases in this series are particularly encouraging.

Key takeaways for clinical practice include:

• Laparoscopy should be considered the preferred approach for most ovarian dermoid cysts
• Careful preoperative assessment and patient selection are crucial
• Proper surgical technique, including thorough peritoneal lavage if spillage occurs, can effectively mitigate the risk of chemical peritonitis
• Comprehensive histopathological examination is important to rule out immature or malignant elements
• Long-term follow-up should be part of the management plan

As minimally invasive techniques continue to evolve, laparoscopic management of ovarian dermoid cysts is likely to become even safer and more efficient, further improving outcomes for patients with this common gynecological condition.

Laparoscopic treatment of ovarian dermoid cysts is a safe procedure

Bosn J Basic Med Sci. 2011 Nov; 11(4): 245–247.

Zulfo Godinjak

¹Obstetrics and Gynaecology Hospital, University Clinical Centre of Sarajevo, Patriotske lige 81, 71000 Sarajevo, Bosnia and Herzegovina

Nurija Bilalović

²Department for Clinical Patology and Citology, University Clinical Centre of Sarajevo, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina

Edin Idrizbegović

¹Obstetrics and Gynaecology Hospital, University Clinical Centre of Sarajevo, Patriotske lige 81, 71000 Sarajevo, Bosnia and Herzegovina

¹Obstetrics and Gynaecology Hospital, University Clinical Centre of Sarajevo, Patriotske lige 81, 71000 Sarajevo, Bosnia and Herzegovina

²Department for Clinical Patology and Citology, University Clinical Centre of Sarajevo, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina

^* Corresponding author: Zulfo Godinjak, Obstetrics and Gynaecology Hospital, University Clinical Centre of Sarajevo, Patriotske lige 81, 71000 Sarajevo, Bosnia and Herzegovina Tel: +38733297000; Fax: +38733441815 E-mail: moc. oohay@g_rakifluz

Received 2011 Apr 15; Accepted 2011 Oct 12.

Copyright : © Association of Basic Medical Sciences of FBIH. All rights reservedThis article has been cited by other articles in PMC.

Abstract

Experienced laparoscopic surgeons should consider laparoscopy as an alternative to laparotomy in management of ovarian dermoid cysts in selected cases. The aim of this study was to analyze the safety of laparoscopy in ovarian dermoid cysts treatment and risk of chemical peritonitis. We report 63 cases of patients (mean age of 37) with ovarian dermoid cysts originating from the ovary, treated from 2002 to 2010. Most of the patients underwent cysts removal. In 7 patients salpingo-oophorectomy was performed. We used 15 mm trocars for removing specimens. In patients with dermoid cyst rupture peritoneal cavity was washed out thoroughly with Ringer lactate and drained for 24-48 hours. All the material extracted was sent for a histopathology examination. The diagnosis of mature ovarian dermoid cysts was confirmed in 58 (92. 63%) of cases and immature ovarian dermoid cysts in 5 (7.37%) cases. Dermoid cysts were composed of tissue developed from three germinative layers in 31 (49%) patients, from two germinative layers in 25 (40%), and in 7 (11%) patients from one germinative layer. No intra or postoperative complications occurred. No signs or symptoms of chemical peritonitis were observed regardless of cystic spillage or not. We conclude that the risk of chemical peritonitis can be minimized when undertaking laparoscopic removal of ovarian dermoid cysts if the peritoneal cavity is washed out thoroughly from spillage of cyst contents. Drainage of peritoneal cavity should be performed in the patients with the ruptured dermoid cysts.

KEY WORDS: laparoscopy, ovarian dermoid cysts, chemical peritonitis

INTRODUCTION

Dermoid cysts present the most common germinative ovarian tumor in women of reproductive age. Transvaginal ultrasound and diagnostic laparoscopy have improved management of ovarian dermoid cysts. Laparoscopy is the standard treatment of ovarian dermoid cysts and provides many advantages over laparotomy. However, laparoscopic approach could result in chemical peritonitis caused by the spilled contents of a ruptured dermoid cyst [1]. In addition to chemical peritonitis, the procedure can be complicated by intraperitoneal dissemination of tumor if the dermoid cyst underwent malignant transformation. Intra-peritoneal spillage of contents from an ovarian dermoid cyst may occur after spontaneous rupture of the cyst; therefore it is very important to act promptly. Histologically, dermoid cysts contain different tissues developed from one or all three germinative layers. The most commonly observed are tumors of ectodermic tissue.

MATERIALS AND METHODS

In this study we present 63 patients in whom we diagnosed ovarian dermoid cysts and treated with laparoscopy in the period from 2002 to 2010. The age of patients was from 20 to 54 years (mean age 37). Preoperatively, tumor marker CA 125 was determined for each patient. All patients underwent transvaginal ultrasonography with Doppler for assessment of ovarian pathology. Cysts measurement ranged from 42 to 96 mm in diameter. Three patients had dermoid cysts on both ovaries. In 56 (88.89%) patients we performed laparoscopic cystectomy, in 7 (11.11%) adnexectomy (salpingo-oophorectomy). Firstly, we evacuated the contents of the cyst to reduce the size of cyst, then we evacuated cyst. We used a trocar of 15 mm diameter for the evacuation of cysts. No endobags were used to remove the cysts from the abdomen. In cases of inadvertent rupture of the dermoid cysts, peritoneal lavage with lactated Ringer’s solution was undertaken. A pelvic drain was then placed and left in place for 24-48 hours. Specimens were sent for histopathology analysis and in all patients diagnosis of ovarian dermoid cysts was confirmed. We analyzed the operative outcome, complications and possible factors that could lead to the development of chemical peritonitis.

RESULTS

The obtained values of tumor marker CA 125 were within the normal range in all patients. During the laparoscopic surgical procedure the rupture of dermoid cysts occurred in 38 (60.32%) of 56 patients with cystectomy, and in 3 (42.9%) of 7 in whom we performed adnexectomy. There was no statistically significant difference in the incidence of dermoid cysts rupture in relation to the type of laparoscopy surgery. (X² = 1003, p=0.421). Out of 63 there were 20 patients (3175%) with dermoid cyst diameter larger than 60 mm, and in 43 (69.25%) cyst diameter was less than 60 mm. Rupture occurred in 16 (80%) of 20 cysts of where the diameter was greater than 60 mm and in 22 (51.17%) of 43 whose diameter was less than 60 mm. Intraoperative rupture of the cyst was significantly correlated with the size of ovarian dermoid cysts (cyst diameter greater than 6 cm) (X² = 8.39, p = 0.004). For all cysts we performed histopathology tests which confirmed that the dermoid cysts were derived from the different germ cell layers, as shown in the . Dermoid cysts were composed of the tissue that developed from the three germinative layers in 31 (49%) patients, in 25 (40%) from two layers, and in 7(11%) patients from one germinative layer (). As it can be seen, the largest number of ovarian dermoid cysts developed from all three types of germinative layers. Mature dermoid cysts were confirmed patho-histologically in 58 patients, and immature dermoid cysts in 5 patients. In our study, no intra or postoperative complications occurred, none case of chemical peritonitis was noted, and there were no malignant transformation of ovarian dermoid cysts. All patients were followed up one year by vaginal ultrasound and there were no cases of cyst recurrence.

TABLE 1

Tissue type in ovarian dermoid cysts

Representation of dermoid cysts in relation to the number of germinative layers from which they developed

DISCUSSION

One of the theoretical pitfalls of laparoscopy is the assumed high risk for intraoperative cyst rupture during laparoscopy. In order to reduce intraoperative spillage of cystic we performed removal of the specimen through an endoscopic retrieval bag. Removing cysts in an endobag significantly reduced both operating time and spillage [2]. However, controlled intraperitoneal spillage of contents does not increase postoperative morbidity as long as the peritoneal cavity is thoroughly washed [2]. The risk of granulomatous peritonitis can be minimized by undertaking laparoscopic removal of dermoid cysts with the routine intraoperative use of an endoscopic retrieval bag to prevent intraperitoneal spillage of cysts contents [3]. In this study, the endobag was not used. Instead, the contents of the cysts were aspirated following removal of the cyst content via a 15 mm trocar. Spillage of cyst contents occurred in 38 (60.3%) of 56 patients in whom we performed cystectomy and in 3 (42.9%) of 7 in whom we performed salpingo-oophorectomy. None of the patients had intraoperative complications, nor developed chemical peritonitis following the surgery, as reported by certain authors in their studies. During the cysts extraction, minimal spillage occurred in 42,5% of cases and none developed chemical peritonitis [4].

Spillage of cyst content occurred in 66% of cases, no intra or postoperative complications occurred, and none case of chemical peritonitis was noted [5]. Rupture of ovarian dermoid cyst resulting in chemical peritonitis is very rare and may be associated with malignant transformation [6]. There are studies which report on the chemical peritonitis developing after scattering the contents of the cyst. chemical peritonitis developed after removal of the ovarian dermoid cyst due to scattering of its content despite the use of endobag and thorough irrigation with physiologic fluids [7]. chemical peritonitis develops also in case of spontaneous rupture of the dermoid cyst. When an ovarian cyst ruptures spontaneously an emergency operation is usually performed and the chemical peritonitis is alleviated by irrigating the abdominal cavity [8]. Some other studies suggest that the spilled contents should be aspirated from the peritoneal cavity as soon as possible since it can cause development of chemical peritonitis. Spilled fluid from ovarian dermoid cysts should be removed as soon as possible from the peritoneal cavity in order to prevent prolonged chemical peritonitis [8].

Is the length of contact between the content of the dermoid cyst and peritoneal cavity a decisive factor leading to the development of chemical peritonitis, or is there another factor? Laparotomy should be considered in case where laparoscopy is not feasible due to the size of the cyst or in case of suspected malignancy. Our study criteria for laparotomy were a high suspicion of malignancy and a cyst larger than 10 cm [9]. It is very important to do a complete preoperative diagnosis and then decide which operative method is to be used-laparoscopy or laparotomy. With careful preoperative screening the rate of laparoscopies for treatment of benign ovarian cysts can be increased [9]. However, careful approach is required due to the possibility of unexpected, very rarely, malignancy in ovarian dermoid cysts. We had no cases with malignant degeneratiaon of ovarian dermoid cyst. One should be aware of the possibility of unexpected malignancy when the decision to manage an ovarian mass laparoscopically is made [10]. Bilateral localization is observed in some 10-15% of cases and the estimated incidence of malignant degeneration is 0.5-1.8% [11]. Cystectomy of ovarian dermoid cysts performed by laparoscopy is associated with higher incidence of intra-abdominal spillage than laparotomy, but this is not associated with increase in morbidity [12].

CONCLUSION

Laparoscopy should be considered as a method of choice for the removal of ovarian dermoid cysts. It should be performed by surgeons with considerable experience in advanced laparoscopic surgery. Experienced laparoscopic surgeons should consider laparoscopy as an alternative to laparotomy in management of ovarian dermoid cysts in selected cases. We concluded that the risk of chemical peritonitis can be minimized when undertaking the laparoscopic removal of ovarian dermoid cysts and if the peritoneal cavity is washed out thoroughly from spillage of cysts contents. In patients whom ovarian dermoid cysts ruptured, the peritoneal cavity should be drained.

REFERENCES

[1] Clement D, Barranger E, Benchimol Y, uzan S. Chemical peritonitis: a rare complication of an iatrogenic ovarian dermoid cyst rupture. Surg Endosc. 2003;17(4):658. [PubMed] [Google Scholar][2] Campo S, Garcea N. Laparoscopic conservative excision of ovarian dermoid cysts with and without an endobag. J Am Assoc Gynecol Laparosc. 1998;5(2):165–70. [PubMed] [Google Scholar][3] Kondo W, Bourdel N, Cotte B, Tran X, Botchorishvili R, Jardon K, et al. Does prevention of intraperitoneal spillage when removing a dermoid cyst prevent granulomatous peritonitis? BJOG. 2010;117(8):1027–30. [PubMed] [Google Scholar][4] Kocak M, Dilbaz B, Ozturk N, Dede S, Altay M, Dilbaz S, et al. Laparoscopic management of ovarian dermoid cysts: a review of 47 cases. Ann Saudi Med. 2004;24(5):357–60. [PMC free article] [PubMed] [Google Scholar][5] Berg C, Berndorff U, Diedrich K, Malik E. Laparoscopic management of ovarian dermoid cysts. A series of 83 cases. Arch Gynecol Obstet. 2002;266(3):126–9. [PubMed] [Google Scholar][6] da Silva BB, dos Santos AR, Lopes-Costa PV, Sousa-Junior EC, Correa-Lima MV, Pires CG. Ovarian dermoid cyst with malignant transformation and rupture of the capsule associated with chemical peritonitis: a case report and literature review. Eur J Gynaecol Oncol. 2009;30(2):226–8. [PubMed] [Google Scholar][7] Mendilcioglu I, Zorlu CG, Trak B, Ciftci C, Akinci Z. Laparoscopic management of adnexal masses. Safety and effectiveness. J Reprod Med. 2002;47(1):36–40. [PubMed] [Google Scholar][8] Koshiba H. Severe chemical peritonitis caused by spontaneous rupture of an ovarian mature cystic teratoma: a case report. J Reprod Med. 2007;52(10):965–7. [PubMed] [Google Scholar][9] Mettler L, Jacobs V, Brandenburg K, Jonat W, Semm K. Laparoscopic management of 641 adnexal tumors in Kiel, Germany. J Am Assoc Gynecol Laparosc. 2001;8(1):74–82. [PubMed] [Google Scholar][10] Mayer C, Miller DM, Ehlen TG. Peritoneal implantation of squamous cell carcinoma following rupture of a dermoid cyst during laparoscopic removal. Gynecol Oncol. 2002;84:1, 180–3. [PubMed] [Google Scholar][11] Imme A, Caglia P, Tracia A, Gandolfo L, Cavallaro G, Amodeo C. [Laparoscopic treatment in a case of torsion of ovarian benign mature teratoma. Clinical case and review of the literature] Chir Ital. 2002;54(6):907–11. [PubMed] [Google Scholar][12] Laberge PY, Levesque S. Short-term morbidity and long-term recurrence rate of ovarian dermoid cysts treated by laparoscopy versus laparotomy. J Obstet Gynaecol Can. 2006;28(9):789–93. [PubMed] [Google Scholar]

Surgery for Ovarian Cysts | Michigan Medicine

Surgery Overview

When an ovarian growth or cyst needs to be closely looked at, a surgeon can do so through a small incision using laparoscopy or through a larger abdominal incision (laparotomy). Either type of surgery can be used to diagnose problems such as ovarian cysts, adhesions, fibroids, and pelvic infection. But if there is any concern about cancer, you may have a laparotomy. It gives the best view of the abdominal organs and the female pelvic organs. Then, if the doctor finds ovarian cancer, he or she can safely remove it.

During surgery, a noncancerous cyst that is causing symptoms can be removed (cystectomy), leaving the ovary intact. In some cases, the entire ovary or both ovaries are removed, particularly when cancer is found.

What To Expect After Surgery

General anesthesia
usually is used during surgery.

After a laparoscopy, you can resume normal activities within a day. But you should avoid strenuous activity or exercise for about a week.

After a laparotomy, you may stay in the hospital from 2 to 4 days and return to your usual activities in 4 to 6 weeks.

Why It Is Done

Surgery is used to confirm the diagnosis of an ovarian cyst, remove a cyst that is causing symptoms, and rule out ovarian cancer.

Surgery for an ovarian cyst or growth may be advised in the following situations:

• Ovarian growths (masses) are present in both ovaries.
• An ovarian cyst that is being watched does not get smaller or go away in 2 to 3 months.
• An ultrasound exam suggests that a cyst is not a simple functional cyst.
• You have an ovarian growth and you:
  • Have never had a menstrual period (for example, a young girl).
  • Have been through menopause (postmenopausal woman).
  • Use birth control pills (unless you are using low-dose progestin-only pills or have missed a pill, which would make an ovulation-related functional cyst more likely).
• Your doctor is concerned that ovarian cancer may be present. In this case, it is also advised that you see a gynecologic oncologist.

How Well It Works

An ovarian cyst can be removed from an ovary (cystectomy), preserving the ovary and your fertility. But it is possible for a new cyst to form on the same or opposite ovary after a cystectomy. New cysts can only be completely prevented by removing the ovaries (oophorectomy).

Risks

Risks of ovarian surgery include the following:

• Ovarian cysts may come back after a cystectomy.
• Pain may not be controlled.
• Scar tissue (adhesions) may form at the surgical site, on the ovaries or fallopian tubes, or in the pelvis.
• Infection may develop.
• The bowel or bladder may be damaged during surgery.

What To Think About

Surgery may be recommended if you have a large cyst, cysts in both ovaries, or other characteristics that may suggest ovarian cancer. Ovarian cancer can occur in women of all ages, but the incidence increases after menopause.

Credits

Current as of:
July 17, 2020

Author: Healthwise Staff
Medical Review:
Sarah Marshall MD – Family Medicine
Martin J. Gabica MD – Family Medicine
Kathleen Romito MD – Family Medicine
Kirtly Jones MD – Obstetrics and Gynecology

Current as of: July 17, 2020

Author:
Healthwise Staff

Medical Review:Sarah Marshall MD – Family Medicine & Martin J. Gabica MD – Family Medicine & Kathleen Romito MD – Family Medicine & Kirtly Jones MD – Obstetrics and Gynecology

Factors that increase the risk of leakage during surgical removal of benign cystic teratomas | Human Reproduction

Abstract

The contents of mature cystic teratomas can be a potent irritant resulting in chemical peritonitis. Using a retrospective cohort, we examined the various risk factors for leakage of benign cystic teratomas during laparoscopy and laparotomy. Cyst leakage of the benign cystic teratoma contents was the primary endpoint. In all, 158 women underwent surgery for a total of 178 ovarian benign cystic teratomas. Statistical analysis was performed using χ², Mann–Whitney U and multivariate logistic regression analysis. A total of 115 benign cystic teratomas was successfully removed without intra-operative leakage and 63 underwent intra-operative leakage either at laparoscopy or laparotomy. The likelihood of success of removing the benign cystic teratoma intact was unrelated to age, pre-operative size or surgical technique. There was no difference among cystectomies performed by laparotomy in surgeon experience or the presence of adhesions. However, surgeons with more laparoscopic experience (>35 laparoscopies/year) were less likely to have intra-operative leakage (relative risk: 0.5, 95% confidence interval: 0.2, 1.2) compared to surgeons with less experience (<20/year) at cystectomy (26.1 versus 51.2% respectively). Oophorectomy significantly reduced the frequency of intra-operative leakage at both laparoscopy and laparotomy (14.7%). These findings suggest that laparoscopic experience can reduce the risk of leakage at cystectomy. At laparotomy, lack of surgeon postgraduate years of experience was not a risk factor for leakage.

Introduction

The management of mature cystic teratomas of the ovary has changed dramatically following advances in endoscopic equipment and techniques. As a result, benign cystic teratomas are often managed laparoscopically with shorter recovery periods and smaller incisions (Yuen et al., 1997). However, laparoscopy has reduced tactile feedback and requires specimen removal through small incisions that may increase the leakage at surgery. This is a matter for concern, since the contents of benign cystic teratomas may cause significant peritonitis (Pantoja et al., 1975; Fiedler et al., 1996).

This study was undertaken to identify the risk factors associated with the intra-operative leakage of benign cystic teratomas. Specifically, we sought to determine whether surgeons’ experience, surgical technique, presence of adhesions and cyst size predisposed to intra-operative leakage.

Materials and methods

Our computerized surgical server was used to screen consecutive cases seen at the Northwestern Memorial Hospital from January 1993 through May 1998. The diagnosis of benign cystic teratoma was made following pathological examination of the surgical specimen. Initially, 192 potential cases were identified. After an initial chart review, 14 cases were excluded for the following reasons: benign cystic teratoma not confirmed by pathology (n = 5) or the complete record was not available (n = 9). This left 178 cysts in 158 women available for analysis. Pertinent information regarding each patient’s age, gravidity, parity, previous abdominal surgeries, previous benign cystic teratoma cysts and subsequent admissions was recorded. Site of the cyst, presence or absence of adhesions and mean diameter by ultrasound and at surgery as estimated with a calibrated instrument were also recorded. Surgical procedure, including laparoscopy versus laparotomy, method of cyst opening and dissection and the performance of concurrent oophorectomy were noted. Benign cystic teratoma leakage was confirmed if the cyst leaked prior to placement into an endoscopic bag at laparoscopy or at any time when the cyst fluid was visible prior to specimen removal. The phase of surgery when leakage occurred was also recorded. The surgical operating time was measured from skin incision to closure. The estimated blood loss was measured at laparoscopy by comparing the volume of irrigation fluid used with the volume of fluid collected after the procedure was completed. At laparotomy, the blood loss was estimated by anaesthesia personnel and corroborated by the circulating nurse.

Each surgeon’s experience was estimated by calculating the average number of laparoscopic cases per year performed from 1993 to 1997. Number of years as a physician was determined based on the year of graduation from medical school as reported to the American Medical Association. Patients under the resident service were cared for by physicians undergoing training under the supervision of an experienced surgeon. Statistical analysis was performed using SPSS Version 6.1.1 (SPSS Inc., Chicago, IL, USA). Dichotomous variables were compared by χ² test. Continuous variables were compared with two-sided sample t-test and for non-parametric analysis the Mann–Whitney U-test. Multiple logistic regression was also performed.

Results

There were no significant differences in age, gravidity, history of previous benign cystic teratoma, pelvic surgery or presentation to the resident service between women with and without intra-operative leakage (Table I). There was no difference between cysts that leaked and those that did not in location (left or right), mean diameter at pre-operative ultrasound, or diameter as estimated at surgery (Table II). The presence of adhesions did not increase the risk of intra-operative leakage. Of the 178 cysts in the study, 34 were removed by oophorectomy and most (29) did not undergo intra-operative leakage (85.3%). Of those that did (14.7%), three occurred at laparotomy and two at laparoscopy. Leakage occurred while performing adhesiolysis (n = 2), during specimen removal (n = 2), or was not specified (laparotomy). In all, 144 cysts were removed by cystectomy; 80 at laparotomy and 64 by laparoscopy. The overall incidence of leakage at cystectomy was not statistically different between patients undergoing laparotomy (38.7%) and laparoscopy (42.2%). There was no difference in leakage among cystectomies performed by the resident service or by the presence of adhesions. Among patients undergoing cystectomy by laparotomy, surgeon postgraduate years and pre-operative size were not associated with intra-operative leakage (Table III).

The most commonly performed technique employed for laparoscopic cystectomy was using three or four punctures using a 10 mm umbilical port and a second 10 mm trocar for specimen removal. Monopolar needle electrosurgery was used to score the ovarian capsule followed by enucleation without intentionally puncturing the cyst. Copious irrigation was used following cystectomy (1–4 l). Success or failure of cystectomy was not influenced by surgical techniques such as use of aquadissection, blunt or sharp dissection (data not shown).

Surgeon laparoscopic experience was distributed in a bimodal pattern, with 39 surgeons performing <20 laparoscopic cases per year and five surgeons performing >35 cases per year. No surgeon averaged between 20 and 35 laparoscopic cases per year. Patients who underwent laparoscopic cystectomy by experienced laparoscopic surgeons (>35 laparoscopies/year) were less likely to have intra-operative leakage (relative risk: 0.5, 95% confidence interval: 0.2–1.2) (Table III). Among patients undergoing unilateral cystectomy without concurrent procedures, estimated blood loss and operating time were not different between women (leakage, no leakage, laparoscopy, laparotomy; data not shown). The phase at which leakage occurred during cystectomy did not statistically differ for laparoscopy and laparotomy, including respectively at ovarian capsule incision (14.1 versus 11.3%), cyst dissection (17.2 versus 22.5%) and during cyst removal (9.4 versus 3.8%). A backward likelihood ratio logistic regression analysis was performed on the entire dataset to assess further factors related to intra-operative benign cystic teratoma leakage including surgeon years of experience, surgeon laparoscopic experience, preoperative size, laparoscopy, and presence of adhesions. In the final logistic model, only laparoscopic experience was found to protect against intra-operative leakage (P = 0.058).

Discussion

Leblanc in 1831 first used the term `kyste dermoid’ in referring to a tumour at the base of a horse’s skull (see Commerci et al., 1994). Since mature cystic teratomas are composed of all three germ cell layers, the term `dermoid’ is not considered correct. Mature cystic teratomas are thought to arise from primordial germ cells (Pantoja et al., 1975). This theory is supported by the distribution of these tumours along the lines of migration from the yolk sac to the primitive gonad. The majority of these tumours occur during the reproductive years lending further support to the germ cell theory.

With the introduction of high-resolution transvaginal ultrasonography, the diagnosis of a benign cystic teratoma can be made with greater accuracy. Cystic teratomas are suspected if any one of the following three sonographic findings is present in a woman of reproductive age: a densely echogenic tubercle associated with a cystic echo pattern, a thin, echogenic, band-like echo or a dense echo pattern with or without a cystic component (Cohen and Sabbagha, 1993). In a prospective series, a diagnostic accuracy of 97% was noted in predicting cystic teratomas (Caspi et al., 1996). Unfortunately, malignancy complicates 0.17–3% of cases (Commerci et al., 1994) and cannot be completely excluded on the basis of ultrasound findings, even with colour Doppler flow imaging (Luxman et al., 1996). Also, benign cystic teratomas may be at risk for chronic leakage (1%), acute rupture (1–3%) or torsion (3%), and as a result surgical intervention is often recommended (Commerci et al., 1994). Careful observation (Caspi et al., 1997) or cystectomy should be considered in patients who desire future fertility.

The rate of bilateral mature cystic teratomas was 11% in this study, consistent with other studies (Commerci et al., 1994). In the past, sampling of the contralateral ovary was recommended to rule out a second mature cystic teratoma. Unfortunately, indiscriminate removal of ovarian tissue rarely leads to the identification of a teratoma. In addition, potential complications of ovarian biopsy include haemorrhage, infection, adhesion formation and possible reduction of follicles (Toaff et al., 1976). For these reasons, careful inspection of the contralateral ovary is recommended with diagnostic cyst aspiration followed by cystectomy if indicated.

Although several studies have emphasized the importance of experience (Howard, 1995; Nitke et al., 1996), this is the first paper to study the effects of surgeon experience on leakage from mature cystic teratomas. The current study suggests that cystectomy by laparotomy is highly insensitive to surgeon experience as measured in years. Postgraduate years offer no relative benefit to preventing benign cystic teratoma leakage at laparotomy. However, laparoscopic experience is highly predictive of success at laparoscopic cystectomy. Those surgeons performing <20 cases per year are more likely to have inadvertent leakage at laparoscopic cystectomy. In light of the concerns of chemical peritonitis from benign cystic teratoma cyst fluid, less experienced laparoscopic surgeons are advised to involve more experienced surgeons during endoscopic management, or to consider laparotomy. This finding also helps to validate the Society for Reproductive Surgeons’ recommendation that laparoscopic cystectomy be considered a level II procedure (Keye, 1994).

In the only randomized prospective study reporting leakage rates (Yuen et al., 1997) during the management of benign ovarian cysts, the overall frequency of inadvertent leakage was similar for laparoscopy (27%) and laparotomy (30%). Unfortunately, only 20 benign cystic teratomas were managed by cystectomy. In that study, the benign cystic teratoma rupture rate during cystectomy at laparotomy was 44% compared to 18% in the laparoscopy group. This was similar to the current findings, with cystectomy leakage at laparotomy (39%) occurring more frequently at laparoscopy than by experienced surgeons (26%). Other observational studies have reported leakage rates at laparoscopic resection of anywhere between 13 and 100% (Nezhat et al., 1989; Bollen et al., 1992; Reich et al., 1992; Chapron et al. , 1994; Howard, 1995; Lin et al., 1995; Teng et al., 1996; Ulrich et al., 1996; Shalev et al., 1998).

Granulomatous chemical peritonitis has been previously reported in at least 100 patients (Wolfe et al., 1984). Peritonitis associated with the leakage of benign cystic teratomas is characterized by multiple small yellow–white implants and dense adhesions (Stern et al., 1981). Microscopically, these lesions are granulomas with lipoid-laden macrophages, lymphocytes, plasma cells and foreign-body giant cells present (Kistner et al., 1952; Stuart and Smith, 1983). Chronic peritoneal irritation secondary to leakage can mimic pelvic inflammatory disease, carcinomatosis or tuberculous peritonitis. Keratin and sebum are considered potent irritants (Kurrein and Fothergill, 1961).

At laparotomy, intraperitoneal leakage during ovarian cystectomy can be minimized by exteriorizing the ovary and placing packs prior to ovarian capsule incision. A similar approach can be taken at laparoscopy with placement of the ovary into a bag prior to cystectomy. Some authors argue that copious irrigation will reduce or prevent the risk of peritonitis at laparoscopic cystectomy. For this reason, benign cystic teratoma cysts have been managed laparoscopically without regard to cyst leakage (Hessami et al., 1995; Howard, 1995). Although we agree that irrigation is an important component of any surgery, it is not a substitute for experience. As demonstrated by this study, laparoscopic experience can reduce benign cystic teratoma leakage to a minimum. Also, benign cystic teratoma fluid is commonly viscous and may contain other potentially inflammatory products, including hair, sebum, bone, cartilage and fat. If these contents are allowed to escape, they may be difficult to remove manually or with irrigation. Irrigation in the Trendelenberg position may also displace these products into the upper abdomen or other areas not easily visualized. Also, lavage failed to reduce the level of inflammation and adhesion formation down to control levels as assessed histologically in the rabbit model (Fiedler et al., 1996).

The laparoscopic approach to large benign cystic teratoma cysts (>10 cm diameter) may provide some technical difficulties to specimen removal. Commercially available endoscopic bags often do not open to beyond 6–10 cm in diameter. To facilitate removal of large specimens, some authors suggest the use of laparoscopic assisted vaginal resection (Pardi et al., 1995; Teng et al., 1996), extending the abdominal incision (Shalev et al., 1998) or aspirating and irrigating the cyst fluid until the fluid clears, followed by cystotomy closure and subsequent cystectomy (Ulrich et al., 1996). In our series, none of the benign cystic teratomas exceeded 10 cm in diameter.

This is the largest observational study to date comparing the management of benign cystic teratomas by laparoscopy and laparotomy. We were able to examine the role of cyst size, adhesions and experience on leakage rate. As with all observational studies, we are limited in our conclusions. It is possible that a residual confounding factor was unmeasured. For example, we did not subdivide the number of advanced laparoscopic cases performed by each surgeon when estimating laparoscopic experience. We could have also attempted to quantify surgeon experience using the average number of cystectomies of all types for laparotomy and laparoscopy. This would have required reviewing thousands of charts. Despite these limitations, we were able to demonstrate a trend with overall laparoscopic experience.

In conclusion, benign cystic teratoma leakage at surgery can be significantly reduced if an oophorectomy is performed. However, oophorectomy should only be considered in patients who are not interested in preserving ovarian function. The method of access (laparoscopy versus laparotomy) does not influence the overall rate of benign cystic teratoma leakage at cystectomy. However, if cystectomy is attempted by laparoscopy, benign cystic teratomas are less likely to leak when the operation is performed by an experienced endoscopic surgeon.

Table I.

Patients undergoing laparoscopy or laparotomy for benign cystic teratoma grouped according to whether or not intra-operative leakage occurred

Variable .	No leakage .	Leakage .
aData presented as n or mean ± SEM.
There were no significant differences between the two patient groups.
Patients (n)	102	56
Age (years)a	32.5 ± 0.8	30.8 ± 0.9
Graviditya	1.5 ± 0.1	1.1 ± 0.2
Previous mature cystic teratoma (%)	7 (7)	5 (9)
Previous pelvic surgery (%)	22 (22)	14 (25)
Presenting to resident service (%)	14 (14)	8 (14. 3)

Table I.

Patients undergoing laparoscopy or laparotomy for benign cystic teratoma grouped according to whether or not intra-operative leakage occurred

Variable .	No leakage .	Leakage .
aData presented as n or mean ± SEM.
There were no significant differences between the two patient groups.
Patients (n)	102	56
Age (years)a	32.5 ± 0.8	30.8 ± 0.9
Graviditya	1.5 ± 0.1	1.1 ± 0.2
Previous mature cystic teratoma (%)	7 (7)	5 (9)
Previous pelvic surgery (%)	22 (22)	14 (25)
Presenting to resident service (%)	14 (14)	8 (14.3)

Variable .	No leakage .	Leakage .
aData presented as n or mean ± SEM.
There were no significant differences between the two patient groups.
Patients (n)	102	56
Age (years)a	32.5 ± 0.8	30.8 ± 0.9
Graviditya	1.5 ± 0.1	1.1 ± 0.2
Previous mature cystic teratoma (%)	7 (7)	5 (9)
Previous pelvic surgery (%)	22 (22)	14 (25)
Presenting to resident service (%)	14 (14)	8 (14.3)

Table II.

Factors associated with benign cystic teratoma leakage at oophorectomy and cystectomy, with cysts grouped according to whether or not leakage occurred

Variable .	No leakage .	Leakage .
aData presented as median (25 quartile, 75 quartile).
There were no significant differences between the two groups.
Cysts (n)	115	63
Left side (%)	61 (53)	37 (59)
Size by ultrasound (cm)a	5.3 (4.0, 9.0)	5.0 (4.0, 6.5)
Size at surgery (cm)a	4.8 (3.2, 6.5)	4.0 (3.0, 5.8)
Adhesions location (%)
Ipsilateral	11 (9.6)	8 (12.7)
Contralateral	7 (6.0)	3 (4.5)
Other	9 (7.8)	3 (4.8)

Variable .	No leakage .	Leakage .
aData presented as median (25 quartile, 75 quartile).
There were no significant differences between the two groups.
Cysts (n)	115	63
Left side (%)	61 (53)	37 (59)
Size by ultrasound (cm)a	5.3 (4.0, 9.0)	5.0 (4.0, 6.5)
Size at surgery (cm)a	4.8 (3.2, 6.5)	4.0 (3.0, 5.8)
Adhesions location (%)
Ipsilateral	11 (9.6)	8 (12.7)
Contralateral	7 (6.0)	3 (4.5)
Other	9 (7.8)	3 (4.8)

Table II.

Factors associated with benign cystic teratoma leakage at oophorectomy and cystectomy, with cysts grouped according to whether or not leakage occurred

Variable .	No leakage .	Leakage .
aData presented as median (25 quartile, 75 quartile).
There were no significant differences between the two groups.
Cysts (n)	115	63
Left side (%)	61 (53)	37 (59)
Size by ultrasound (cm)a	5.3 (4.0, 9.0)	5.0 (4.0, 6.5)
Size at surgery (cm)a	4.8 (3.2, 6.5)	4.0 (3.0, 5.8)
Adhesions location (%)
Ipsilateral	11 (9.6)	8 (12.7)
Contralateral	7 (6.0)	3 (4.5)
Other	9 (7.8)	3 (4.8)

Variable .	No leakage .	Leakage .
aData presented as median (25 quartile, 75 quartile).
There were no significant differences between the two groups.
Cysts (n)	115	63
Left side (%)	61 (53)	37 (59)
Size by ultrasound (cm)a	5.3 (4.0, 9.0)	5.0 (4.0, 6.5)
Size at surgery (cm)a	4.8 (3.2, 6.5)	4.0 (3.0, 5.8)
Adhesions location (%)
Ipsilateral	11 (9.6)	8 (12.7)
Contralateral	7 (6.0)	3 (4.5)
Other	9 (7.8)	3 (4.8)

Table III.

Factors associated with leakage at benign cystic teratoma cystectomy

.	Laparotomy .			Laparoscopy .
Variable .	No leakage .	Leakage .	Significance .	No leakage .	Leakage .	Significance .
Data presented as n, mean ± SEM, percent or median (25 quartile, 75 quartile).
*P > 0.05.
RR = relative risk, CI = confidence interval.
aAdhesions could not have been predicted pre-operatively because only 25% of patients had undergone previous abdominal or pelvic surgery. No patients had a diagnostic laparoscopy followed by laparotomy.
Cystectomies (n)	49	31		37	27
Resident service (%)	6 (12.2)	3 (9.7)	RR 0.8 (95%CI 0.3–2.3)	7 (18.9)	6 (22.2)	RR 1.1 (95%CI 0.5–2.4)
Adhesions present (%)a	10 (20. 4)	6 (19.4)	RR 1.0 (95%CI 0.4–2.1)	2 (5.4)	4 (14.8)	RR 1.7 (95%CI 0.8–3.5)
Surgeon experience (years)	15.8 ± 1.4	15.9 ± 2.0	*
Experienced laparoscopist (>35/year)				17	6	RR 0.5 (95%CI 0.2–1.2)
Less experienced laparoscopist (<20/year)				20	21
Preoperative size (cm)	5.5 (4.1, 6.9)	5.0 (4.0, 7.0)	*	4.2 (3.5, 6.1)	5.0 (4.0, 7.0)	*

.	Laparotomy .			Laparoscopy .
Variable .	No leakage .	Leakage .	Significance .	No leakage .	Leakage .	Significance .
Data presented as n, mean ± SEM, percent or median (25 quartile, 75 quartile).
*P > 0.05.
RR = relative risk, CI = confidence interval.
aAdhesions could not have been predicted pre-operatively because only 25% of patients had undergone previous abdominal or pelvic surgery. No patients had a diagnostic laparoscopy followed by laparotomy.
Cystectomies (n)	49	31		37	27
Resident service (%)	6 (12.2)	3 (9.7)	RR 0.8 (95%CI 0.3–2.3)	7 (18.9)	6 (22.2)	RR 1.1 (95%CI 0.5–2.4)
Adhesions present (%)a	10 (20.4)	6 (19. 4)	RR 1.0 (95%CI 0.4–2.1)	2 (5.4)	4 (14.8)	RR 1.7 (95%CI 0.8–3.5)
Surgeon experience (years)	15.8 ± 1.4	15.9 ± 2.0	*
Experienced laparoscopist (>35/year)				17	6	RR 0.5 (95%CI 0.2–1.2)
Less experienced laparoscopist (<20/year)				20	21
Preoperative size (cm)	5.5 (4.1, 6.9)	5.0 (4.0, 7.0)	*	4.2 (3.5, 6.1)	5.0 (4.0, 7.0)	*

Table III.

Factors associated with leakage at benign cystic teratoma cystectomy

.	Laparotomy .			Laparoscopy .
Variable .	No leakage .	Leakage .	Significance .	No leakage .	Leakage .	Significance .
Data presented as n, mean ± SEM, percent or median (25 quartile, 75 quartile).
*P > 0.05.
RR = relative risk, CI = confidence interval.
aAdhesions could not have been predicted pre-operatively because only 25% of patients had undergone previous abdominal or pelvic surgery. No patients had a diagnostic laparoscopy followed by laparotomy.
Cystectomies (n)	49	31		37	27
Resident service (%)	6 (12.2)	3 (9.7)	RR 0.8 (95%CI 0.3–2.3)	7 (18.9)	6 (22.2)	RR 1.1 (95%CI 0.5–2. 4)
Adhesions present (%)a	10 (20.4)	6 (19.4)	RR 1.0 (95%CI 0.4–2.1)	2 (5.4)	4 (14.8)	RR 1.7 (95%CI 0.8–3.5)
Surgeon experience (years)	15.8 ± 1.4	15.9 ± 2.0	*
Experienced laparoscopist (>35/year)				17	6	RR 0.5 (95%CI 0.2–1.2)
Less experienced laparoscopist (<20/year)				20	21
Preoperative size (cm)	5.5 (4.1, 6.9)	5.0 (4.0, 7.0)	*	4.2 (3.5, 6.1)	5.0 (4.0, 7.0)	*

.	Laparotomy .			Laparoscopy .
Variable .	No leakage .	Leakage .	Significance .	No leakage .	Leakage .	Significance .
Data presented as n, mean ± SEM, percent or median (25 quartile, 75 quartile).
*P > 0.05.
RR = relative risk, CI = confidence interval.
aAdhesions could not have been predicted pre-operatively because only 25% of patients had undergone previous abdominal or pelvic surgery. No patients had a diagnostic laparoscopy followed by laparotomy.
Cystectomies (n)	49	31		37	27
Resident service (%)	6 (12.2)	3 (9.7)	RR 0.8 (95%CI 0.3–2.3)	7 (18.9)	6 (22.2)	RR 1.1 (95%CI 0.5–2. 4)
Adhesions present (%)a	10 (20.4)	6 (19.4)	RR 1.0 (95%CI 0.4–2.1)	2 (5.4)	4 (14.8)	RR 1.7 (95%CI 0.8–3.5)
Surgeon experience (years)	15.8 ± 1.4	15.9 ± 2.0	*
Experienced laparoscopist (>35/year)				17	6	RR 0.5 (95%CI 0.2–1.2)
Less experienced laparoscopist (<20/year)				20	21
Preoperative size (cm)	5.5 (4.1, 6.9)	5.0 (4.0, 7.0)	*	4.2 (3.5, 6.1)	5.0 (4.0, 7.0)	*

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© European Society of Human Reproduction and Embryology

Laparoscopic Dermoid Ovarian Cystectomy

Download Video of Laparoscopic Bilateral Dermoid Ovarian Cystectomy by Dr R K Mishra (176 MB)

Laparoscopic Dermoid Ovarian Cystectomy

Mature cystic teratomas, often referred to as dermoid cysts, would be the most common germ cell tumors with the ovary. Within the recent years, trans vaginal sonographic carried out ovarian dermoid cysts along with laparoscopic approach have greatly improved the treatment of this benign lesion. We retrospectively reviewed the results of laparoscopic surgery for suspected ovarian dermoid cysts. A typical benign tumour that appears by having an ovary is really a dermoid cyst. Dermoid cysts originated from primitive skin tissues which has been within the ovary from birth. The fluid inside is sebaceous material, as with a blackhead, and quite often contains hair. Dermoid cysts are more common in ladies, sometimes in the ovaries. Many questions come to mind regarding by using a laparoscopic procedure. A few of the more frequent will be addressed and answered. It usually is better to consult an accredited healthcare professional immediately in case you experience any of the symptoms which can be regarded as a crisis.

How dermoid cyst form and is it dangerous?

Benign cystic teratoma, or as commonly addressed dermoid cysts, are basically germ cell tumors of the ovary. Pathologically, they are enrolled under group of benign mature teratomatas. They account for about 20 – 25% of all ovarian. The prevalence of malignant transformation in dermoid cysts has been reported as 1- 3 %. Most of dermoid cysts occur without significant clinical symptoms and they are often discovered incidentally during pelvic examination or routine ultrasound.

What are the advantage of laparoscopic dermoid cyst?

The phobia of spillage complications existed for too long time up to now challenged by many laparoscopists. Accordingly, laparoscopic approach is becoming increasingly accepted plus much more commonly adopted since 1989. Since the majority of cases with benign cystic teratoma are of reproductive age and even preserve fertility, a conservative approach is good to minimize post operative adhesions thereby decrease chances to compromise fertility.

Trained endoscopic surgeons became well informed to approach dermoid cysts via endoscopic rout and reported satisfactory results with out complications. Inside our study, we appraise the safety and efficacy of laparoscopic control over benign cystic teratoma and present some guidelines and tricks to improve connection between surgery and avoid possible complications that may derive from cyst spillage. We at World Laparoscopy Hospital demonstrated that the usage of endobag creates satisfactory and easy elimination of content of dermoid cyst.

What is the operative technique of laparoscopic ovarian dermoid cystectomy?

Access is done either by open technique or by veress needle technique It is recommended against steep Trenedelenberg’s position to avoid any potential for migration of spilled material of dermoid cyst to upper abdomen during laparoscopic surgery. This could be little awkward during minimal access surgery but we atone for this by proper bowel retraction and positioning of bowels to upper abdomen with all the fan retractor or nathanson retractor. After obtaining clear view for pelvis, surgeon should do lysis of the existing adhesions allowing free mobilization and dissection of the dermoid ovarian cysts. In cases designed for laparoscopic dermoid ovarian cystectomy, according to dissection and electro surgical dissection principle applied the policies recommended by Dr R . K. Mishra.

The gynecologist should add some modifications from side to facilitate surgery and add safety just in case any spillage happen. A grasper forceps or striker mini alligator was utilized to use traction on ovarian ligament and steady the ovary. Combined uterine manipulation plus grasping ovarian ligament allows keeping the cysts on ovaries steady during steps of cystectomy. It was facilitated by squeezing the ovary between body of uterus and lateral pelvic wall to take care of steady and accessible dissection from the cyst. First, cleavage plane is made by diathermy spatula or Maryland’s forceps. A ovarian cystic plane is widened between cyst capsule and stroma of the ovary and hydro dissection continue the enucleation steadily. Combined hydro dissection and with blunt pealing of capsule with the help of maryland will complete the job easily. Gynecologists use laparoscopic harmonic scalpel sometime and cutting coagulation forceps occasionally for dissection and hemostats. It possesses a great value for multifunction since its narrow tip allows precise dissection of cyst capsule, also grasping and traction featuring its serrated edge was quite secure.

The blade of harmonic scalpel or with the maryland instrument allows mono polar coagulation from a bleeding points combined with its sharp scissors on its proximal end of the blade which was useful for precise incision of tissues. Actually, it saves time which may be consumed for exchanging instruments as well as preserves the pneumoperitoneum stable throughout surgery. Grasping the perimeters with the cyst and slaw traction apart will undress the cyst capsule and provide the dermoid from its bed. Eventually, the cysts were enucleated easily and haemostasis was performed for any bleeding spots encountered during dissection. Because of thick nature of dermoid cyst capsule, blunt dissection and pealing was rather easy and risk of cyst puncture was seldom occurring if keeping in proper tissue planes. In the event that spillage occurs, we immediately turn to vigorous jet wash suction irrigation using warm ringer’s solution. Jet irrigation dislodge and clear any sticky debris from surface of peritoneum and push them towards cul de sac. Gynecologist should use suction irrigation canulae simultaneously from both secondary puncture sites. The evacuated dermoid cyst, together with its contents were shelled out from normal ovarian tissues and removed via trocar sleeve.

You can use Ethicon endobag or nicely prepared gloves endobag to contain the cysts prior to its aspiration or puncture. In this method, the dermoid cyst should be placed in the impermeable bag and only then punctured and aspirated while contained inside the protective good quality endo bag. Any spillage dermoid content material should be securely contained inside the endobag to avoid any risk of spilled material. If spillage occur then copious lavage should done.

What are the complications of dermoid cyst?

The chance of complications like torsion, spontaneous rupture, risk of chemical peritonitis, and malignancy usually makes surgical procedures quite necessary upon diagnosis. Most operative textbooks describe classical treatment for dermoid cysts are already ovarian cystectomy or oophrectomy through laparotomy with utmost choose to avoid spillage of cyst contents. Although laparoscopic surgery has replaced many standard laparotomy techniques, however many skeptical opinions were hesitant about role of laparoscopic surgery for dermoid cyst removal. The opportunity anxiety about spillage of cyst material and possible progression of chemical peritonitis imposed fears of adopting laparoscopic approach.

Conclusion of laparoscopic dermoid ovarian cystectomy?

Using strict adherence to guidelines for preoperative clinical assessment and intra-operative management, laparoscopic management of dermoid cysts appears to be a safe and secure procedure.

Minimally Invasive Laparoscopic Ovarian Cystectomy

What is a Laparoscopic Ovarian Cystectomy?

Let’s begin by me stating that it’s critically important to talk to your gynecologist (or health care provider) during your gynecology well women’s health exams about ALL your physical symptoms (no matter how minor you think they are).  Early detection of any issue, including ovarian cysts, can make a world of difference in your long term health.

A Laparoscopic Ovarian Cystectomy is a  to remove cysts on the ovaries. A cyst is a sac of fluid that can develop inside the ovaries. They can either be benign ovarian cysts or cancerous. Typically, a noncancerous ovarian cyst can be removed while leaving the ovaries intact, which means that natural conception is still possible. If the growths are cancerous, however, the entire ovary or both ovaries may need to be removed.

Ovarian cysts can recur even after they are surgically removed no matter what surgical technique is used. They can return on the ovary that had the operation, or on the other. The only way to eliminate the risk of recurring cysts is to remove both ovaries via oophorectomy.

When is an Laparoscopic Cystectomy Performed?

Ovarian cysts are fairly common. Most cysts are not harmful and usually resolve on their own. However, some cysts can hinder fertility, cause symptoms, or become cancerous.

A Laparoscopic Ovarian Cystectomy may be a recommended treatment option if:

• The patient has cysts or other masses in both ovaries
• An ovarian cyst has not shrunk or disappeared after 3 months
• A cyst is larger than 3 inches in diameter
• A cyst appears to be abnormal or malignant
• Your doctor suspects ovarian cancer

If you have an ovarian cyst, your OB/GYN may recommend an ovarian cystectomy if you also:

• Take birth control pills
• Have not yet started your period (children or teenagers)
• Are a postmenopausal patient

What tests are needed before a Laparoscopic Ovarian Cystectomy?

Sometimes your OB/GYN may want one or more of the following diagnostic tests before the procedure:

Ultrasound

Examining an ovarian cyst via painless and non-invasive ultrasound is very standard and helps achieve a proper diagnosis. Essentially, we will look at the shape (regular or irregular), the size, and the composition of the cyst to determine if it is solid, or fluid-filled, or maybe a combination of the two?

• • Fluid-filled cysts (commonly called simple cysts) are usually not cancerous and often need just observation and close follow-up. If they are large and causing disturbing symptoms, then removal might be recommended.
  • If your cyst(s) are solid or mixed (fluid-filled and solid, usually called complex cysts.), further evaluation to determine if they are cancerous ovarian tumors will be necessary. This may entail surgical treatment.

MRI or CT Scan

Your doctor may recommend an MRI (or a CT Scan) to get a much “better look” at solid tumors, something that a common x-ray is unable to do.

Blood tests

You may be asked for:

• • A pregnancy test if there is any chance you may be pregnant
  • Tests to check your hormone levels
  • A CA-125 test, which is performed to rule out ovarian cancer. This might be needed depending on the characteristic of the cyst on the ultrasound or the MRI if you had one.

How are Ovarian Cystectomies Performed?

An ovarian cystectomy can be performed in one of two ways.

Abdominal surgery

Your doctor will make a large incision in your abdomen and conduct open surgery through the incision. This is often a good choice if there is the possibility of cancer since the large opening gives the doctor a clear view of all the pelvic organs.

Laparoscopic surgery

In this minimally invasive surgery, the doctor makes a few small incisions in the abdomen and inserts the surgical tools through these holes. One instrument is called a laparoscope. It is a thin, flexible instrument with a lighted camera at the end, which guides the surgeon through the procedure. The tissue is removed through these small incisions.

Both procedures are performed under general anesthesia. Generally, an abdominal surgery carries greater risks for infection or damage to tissue. However, it is a better choice when there is a large amount of tissue to be removed, or if the doctor needs to see all of the organs clearly. Laparoscopic surgeries usually have quicker healing times and the patient experiences less pain.

For more information about our advanced minimally invasive outpatient Ovarian Cystectomies surgery, procedures, please visit our Outpatient Hysterectomy Center website.

Risks of Ovarian Cystectomy

An ovarian cystectomy is a relatively safe procedure, but every surgery carries some risk. Risks of ovarian cystectomy include:

• Recurring ovarian cysts
• Pelvic pain
• Infection
• Adhesions – scar tissue that causes the pelvic organs to stick together
• Damage to the bladder, bowel, or other pelvic tissue

Ovarian Cystectomy Recovery Time

Depending on your surgeon, you may need a hospital stay for a few days. In our Los Angeles minimally invasive surgical practice, our procedures are always outpatient and you go home the same day. As soon as you are able, you should stand up and walk for a few minutes to improve your circulation. This is to prevent possible blood clots in the legs.

Be sure to get plenty of rest as well as some light exercise in the days and weeks following your surgery. Avoid any heavy lifting or rigorous exercise. If you have had abdominal surgery, you should be able to return to your normal activities after 4-6 weeks. For a laparoscopy, you may be fully recovered as soon as 2 weeks after the procedure.

About Dr. Thaïs Aliabadi

As one of the nation’s leading obstetricians, Dr. Thaïs Aliabadi offers the very best in gynecology and obstetrics care. Together with her warm professional team, Dr. Aliabadi supports women through all phases of life. She fosters a special one-on-one relationship between patient and doctor.

We invite you to establish care with Dr. Aliabadi if you are near Los Angeles, Beverly Hills, Santa Monica or wish to travel to see us. Please click here to make an appointment or call us at (844) 863-6700.

If a Laparoscopic Ovarian Cystectomy has been recommended for you, please make sure to ask your doctor and surgeon (if they are not the same person) any and all questions you may have about it.

We also invite you to establish care with Dr. Aliabadi. Please click here to make an appointment or call us at (844) 863- 6700.

Highly-trained and honored by the medical community, Dr. Thais Aliabadi is certified by the American Board of Obstetrics and Gynecology and a Diplomat of the American College of Obstetrics and Gynecology. She implements the most advanced, state-of-the-art technology and treatment options. Dr. Aliabadi specializes in up-to-date, minimally invasive surgical techniques, promising her patients shorter recovery times, reduced pain, and the least interruption to their daily lives.

Supported by her warm professional team, Dr. Aliabadi treats women through all phases of life and cherishes the special one-on-one relationship between patient and doctor.

Latest posts by Dr. Thaïs Aliabadi (see all)

Laparoscopic Cystectomy | CU OB-GYN

Laparoscopic cystectomy at a glance

• Laparoscopic cystectomy is the removal of ovarian cysts, or masses, using laparoscopy, a form of minimally invasive surgery.
• Laparoscopy is a surgical technique in which a surgeon inserts a small, lighted telescope-like instrument (laparoscope) into the abdomen through a small incision in order to examine or perform surgery.
• Laparoscopic cystectomy is used to remove cysts and growths on the ovaries that are persistent, enlarging or causing symptoms.
• The aim of a laparoscopic cystectomy is to preserve the fertility of the patient by removing only the cyst or growth and preserving the remaining ovarian tissue.
• Laparoscopic cystectomy is only recommended if the cyst or mass is likely benign (noncancerous).

What is laparoscopic cystectomy?

Laparoscopic cystectomy is a minimally invasive procedure used to identify and remove cysts or masses from one or both ovaries. When a cyst needs to be examined more closely or when a patient experiences symptoms as a result of a cyst, a doctor may recommend a laparoscopic cystectomy.

A woman’s age, health history, symptoms and the type of cyst can all play a role in whether a doctor recommends surgical removal. Surgery might be recommended if:

• The cyst is larger than 3 inches.
• The cyst does not get smaller or go away after two to three menstrual cycles.
• The cyst does not appear to be a functional cyst (a cyst that grows as a result of ovulation).
• The cyst is causing pain or discomfort.

Laparoscopic cystectomy is the preferred surgical procedure for pediatric, teen and reproductive age patients, as the procedure works to preserve the ovary and fertility of the patient. In cases where the cyst is excessively large, malignant cancer is suspected or the patient has reached menopausal age, a surgeon may recommend a different surgical approach and/or removal of the entire ovary.

Read the story, Peyton’s Ovarian Torsion Scare, caused by an ovarian cyst.

What to expect during laparoscopic cystectomy

Laparoscopy is typically performed under general anesthesia. The surgeon will inflate the abdomen with carbon dioxide gas to move the abdominal wall away from the organs to make the organs more visible. Once the abdomen is inflated, the laparoscope is inserted through small incisions made near the belly button. Two to three additional incisions are made at the pubic bone and/or on either side of the lower abdomen. Incision length varies but most incisions are between one-quarter inch and three-quarters of an inch in length.

A camera on the end of the laparoscope transmits a live video feed to a screen for the surgeon as he or she performs the procedure. The doctor will examine the cyst and ovary more closely and remove the cyst using surgical tools that pass through the incisions. During a cystectomy the surgeon works carefully so as not to damage the ovary or fallopian tubes (the tubes that connect the ovary to the uterus), and to preserve the fertility of the patient. Sometimes the cyst will rupture during surgery.

Once the cyst has been removed, the surgeon will close the incisions with stitches. Often times women who have had a laparoscopic cystectomy can go home the same day of their surgery. Recovery time does vary from person to person, but many women return to work and light activity within 1-2 weeks of the procedure.

What are the risks of laparoscopic cystectomy?

Laparoscopic cystectomy is a relatively safe procedure, but like most surgical procedures, it does present potential risks to the patient. Our surgeons are careful to mitigate complications and discuss potential risks with each patient. Minor complications such as infection and irritation of the incisions are possible, as are more serious risks such as:

• Ovarian cysts and endometriomas (cysts in the uterine lining) may reoccur.
• Anesthesia-related issues.
• The formation of hematomas, or swelling due to blood outside a vessel.
• Allergic reactions.
• Nerve damage.
• Blood clot formation in veins that can travel to the lungs.
• Injury to the ovary or fallopian tube which may require removal.
• Injury to an abdominal or pelvic organ.

Women who have had previous abdominal surgery, have pelvic adhesions or who are overweight are at a greater risk of complications. Each of our surgeons takes great care to discuss potential risks and recommend the procedure they believe is best for treating the patient.

Ovarian Cyst Removal – Open Surgery

by Siegal B

Definition

Ovarian cyst removal
is surgery to remove a
cyst
or cysts from one or both of your ovaries.
An open surgery requires an abdominal incision large enough that the doctor can see the cyst and surrounding tissue. It may be done instead of a
laparoscopic surgery
if the cyst is large, there are many cysts, or complications develop during a laparoscopic surgery.

Reasons for Procedure

An ovarian cyst may need to be removed if it is:

• Suspected of being
  cancer
  (the chances are lower if you are young)
• Large—more than 2.5 inches (6.35 centimeters) in diameter
• Solid (rather than containing just fluid)
• Causing pain

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have an ovarian cyst removed, your doctor will review a list of possible complications, which may include:

• Infection
• Bleeding
• Cyst returns after it is removed
• Need for removal of 1 or both ovaries
• Infertility
• Blood clots
• Damage to other organs

Factors that may increase the risk of complications include:

Be sure to discuss these risks with your doctor before the procedure.

What to Expect

Prior to Procedure

Your doctor may do the following:

• Physical exam
• Review of medications
• Blood tests
• Urine test
• CT scan
  —a type of x-ray that uses a computer to make pictures of organs
• Ultrasound
  —a test that uses sound waves to examine the abdomen

Talk to your doctor about what action should be taken if cancer is found during surgery. One option is to remove the ovary.

Leading up to the surgery:

• Talk to your doctor about your medications. You may be asked to stop taking some medications up to 1 week before the procedure.
• Arrange for a ride to and from the hospital. Also, arrange for someone to help you at home.
• Do not eat or drink for at least 8 hours before the surgery.

Anesthesia

General anesthesia
will be used. It will block pain and keep you asleep through the surgery. It will be given through an IV in your hand or arm.

Description of the Procedure

An incision will be made in the abdomen. The abdominal muscles will be separated and the abdomen will be opened.

Next, the cyst will be removed. In some cases, a sample of tissue will be removed for testing. If cancer is found, 1 or both ovaries (if cysts are on both ovaries) may be
removed
. Lastly, stitches will be used to sew the abdominal muscles. The incision will be closed with stitches or staples.

Immediately After Procedure

After the procedure, you will be given IV fluids and medications while recovering.

How Long Will It Take?

1-2 hours

Will It Hurt?

You will have abdominal pain and discomfort for 7-10 days. You will be given pain medication.

Average Hospital Stay

2-3 days

Post-procedure Care

Recovery may take 4-6 weeks. When you return home, do the following to help ensure a smooth recovery:

• Avoid strenuous exercise until your doctor says it is okay.
• Do not resume sexual activity until your doctor says it is okay. You may need to wait 2 weeks.
• Follow your doctor’s guidelines for ultrasound tests. These may need to be done if it is likely that the cysts will return.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occur:

• Signs of infection, including fever and chills
• Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
• Pain that you cannot control with the medications you have been given
• Unexpected amount of vaginal bleeding or discharge
• Cough
  , shortness of breath, or chest pain
• Nausea and/or vomiting that you cannot control with the medications you were given after surgery, or which last for more than 2 days after discharge from the hospital
• Headaches, muscle aches, lightheadedness, or general ill feeling
• Constipation
  or abdominal swelling
• Urinary difficulties
• Onset of pain or swelling in 1 or both legs
• New, unexplained symptoms

If you think you are having an emergency, call for emergency medical services right away.

Dermoid cyst

Dermoid ovarian cyst – direct indication for surgical treatment

Dermoid ovarian cyst – direct indication for surgical treatment
Professor Puchkov K.V. is performing an operation (2020).

I invite you to watch the video, where I will demonstrate an elegant and accurate surgical intervention to remove a dermoid cyst in a plastic container without opening it.

At the end of the video, I will show you the contents of the cyst.

You can read more about the methods on the personal website of Professor Konstantin Viktorovich Puchkov navigate

Dermoid ovarian cyst. Surgical removal by laparoscopic method

Dermoid ovarian cyst. Surgical removal by laparoscopic method
Professor Puchkov K.V. is performing an operation (2020).

Laparoscopy for dermoid ovarian cysts is the “gold standard” for operations, i.e.because it is accompanied by minimal trauma to the abdominal wall, it allows you to very delicately exfoliate the membrane of the cyst without damaging the ovarian tissue.
⠀

Laparoscopy in conjunction with the introduction of an anti-adhesion gel reduces the risk of adhesions in the pelvic area to almost zero.

You can read more about the methods on the personal website of Professor Konstantin Viktorovich Puchkov navigate

Excision of the retroperitoneal dermoid cyst (mature teratoma 15 cm) using laparoscopic access

Excision of the retroperitoneal dermoid cyst (mature teratoma 15 cm) with
using laparoscopic access
…Professor Puchkov K.V. is performing an operation. (2019)

Patient 21 years old. Complaints of bursting pain in the right hypochondrium and
lumbar region. The video shows a transverse CT scan,
where a large cyst with dense walls and bony is defined
fragments inside, which is located between the inferior vena cava and
aorta. With plain laparoscopy, topographic anatomy is shown
surgical intervention zones: hepato-duodenal
ligament, right kidney, duodenum, left renal vein,
inferior vena cava.The anterior wall of the cyst under the IVC, duodenum is clearly visible
and hepato-duodenal ligament. The operation starts with
opening the parietal peritoneum at the lower pole of the cyst between
fascias of Toldy and Gerot. Next 5mm Thunderbeat Olympus
dissection of the walls of the retroperitoneal cyst is performed. Cyst wall capsule
tightly soldered to the back wall of the IVC, which makes it much more difficult
selection. In this regard, the peritoneal dissection was performed medially
IVC and inferior vena cava are maximally separated from the cyst wall.Further
the cyst was opened with a monopolar electrode and contents (800 ml)
aspirated. In the lumen, fat, hair and bone are determined
fragments. After aspiration, the separation of the APF and the anterior
cyst walls in a “blunt” way. Next, the right renal
an artery that is intimately fused with the cyst capsule – held
its neat dissection. The medial edge of the cyst is separated from the anterior
the walls of the aorta and surrounding tissues. The lumbar artery is clipped and
crossed.The base of the cyst in the area of ​​the psoas muscle
coagulated. The cyst is placed in a plastic container and removed from
abdominal cavity. The duration of the operation is 1 hour 50 minutes.
Histological examination – the tumor wall consists of well
differentiated derivatives of germ layers with
predominance of ectodermal derivatives: elements are determined
skin with all its components (epidermis, a layer of fibrous
elastic and adipose tissue, sweat and sebaceous glands,
hair follicles), elements of fibrous and bone tissue.Mature
teratoma (dermoid cyst).

You can read more about the technique on the personal website of Professor Konstantin Viktorovich Puchkov go to

Laparoscopic cystadnexectomy on the left with a dermoid ovarian cyst

Laparoscopic cystadnexectomy on the left.
Professor Puchkov K.V. is performing an operation (2015).

The film shows the technique of removing the uterine appendages with a cyst by a laparoscopic 5 mm LigaSure MEDTRONIC COVIDIEN instrument.The operation is performed on a 46-year-old patient with a 20 cm dermoid cyst. The cyst was previously punctured with a 10 mm ribbed MEDTRONIC COVIDIEN trocar and 800 ml of thick contents were evacuated from it. The hole is sutured with an interrupted suture. Further, the LigaSure instrument performed sequential coagulation and transection of the vortex and own ligaments of the ovary, as well as the fallopian tube. Surgery is carried out quickly and bloodlessly. Mandatory removal of the removed drug using a plastic container.At the end, the appearance of a removed cyst is shown. The duration of the operation is 50 minutes.

You can read more about the methods on the personal website of Professor Konstantin Viktorovich Puchkov navigate

Removal of ovarian cysts: types and methods of operations, rehabilitation

A cyst is a tumor-like formation, inside of which there is a cavity filled with fluid. Ovarian cysts are found quite often, but most of them, about 85%, are benign.However, in a study of women over 50 years old, about half of them show signs of malignancy. Any cyst requires specialist observation and careful instrumental examination. The most effective diagnostic method that allows you to determine the presence of blood flow is Doppler ultrasound.

Ovarian cysts, or benign neoplastic formations, are classified into:

• functional,
• dermoid,
• endometrioid,
• cystadenomas.

Functional cysts, depending on the structure involved in its formation, are subdivided into follicular and corpus luteum cysts. They are formed by the changing hormone levels of the menstrual cycle. A follicle matures in the ovary every month. Upon reaching maturity, it bursts. In its place, a corpus luteum is formed, and the egg continues on its way. This is normal.

Follicular cysts are formed from a follicle that did not rupture during maturation and remained in the ovary.As a result, the formation of the corpus luteum, which is responsible for the production of the hormone progesterone, did not occur. This is manifested by irregularities in the menstrual cycle. Most often, follicular cysts are unilateral.

A corpus luteum cyst is an excess accumulation of fluid at the site of a ruptured follicle. A woman may notice a delay in menstruation and other likely signs of pregnancy.

Functional neoplasms often go away on their own within 3-6 months.However, they require supervision by a specialist, ultrasound control and adherence to the doctor’s recommendations. In some cases, the appointment of combined oral contraceptives is required.

Endometrioid cyst is a cavity filled with blood. Neoplasms of this type arise from an inflammatory disease such as endometriosis, which has spread to the ovaries. Small monthly hemorrhages from the endometriotic lesion formed a cyst. Over time, the blood coagulates and acquires a viscous consistency and brown color.On macroscopic examination, the contents of the cyst resemble dark melted chocolate.

Dermoid cyst refers to mature cystic teratomas. It is believed that during embryonic development, cells of the integumentary epithelium enter the fetal ovary, which normally should not be there. Dermoid cysts are found mainly in adolescents or young women under 40 years of age. Teras in translation from Greek is a monster. This name is probably due to the fact that inside teratomas, in addition to adipose tissue, can also contain hair, nails, teeth and even parts of more complex organs.

Serous cyst (cystadenoma) is externally similar to follicular. However, it has a number of features that make it possible to differentiate it for ultrasound. This is important as some types of cystadenomas tend to become malignant. Serous cysts can be divided into simple and papillary. The latter are characterized by growths of the inner capsule in the form of papillae, from which they got their name. Papillary serous cyst in most cases degenerates into a malignant tumor. If malignancy is suspected, a puncture is not performed, due to the fact that up to 60% of the results are false-negative.Therefore, serous cysts are always subject to surgical removal and subsequent histological examination.

Certain oncological risks are borne by all ovarian neoplasms, with the exception of functional ones, and therefore require surgical treatment followed by research.

This does not mean that all cysts should be removed immediately. However, heavy sports loads, inaccurate sexual relations, abdominal trauma can provoke complications, which carries certain risks.

• Torsion of the cyst pedicle leads to compression of the nerves and blood vessels that feed it. This entails the development of necrotic processes. In women, the pelvic cavity communicates with the abdominal cavity, therefore, the processes of decomposition and inflammation affect the peritoneum with the development of peritonitis. Clinically, torsion of the cyst leg is manifested by cramping abdominal pain, palpitations, fever, vomiting, and nausea.
• Suppuration of the cyst occurs when a secondary bacterial infection is attached, which can be caused by infectious diseases of the pelvic organs.The process is accompanied by a clinical picture of an acute abdomen, fever, and the development of peritonitis.

• Cyst rupture is perhaps the most severe complication. The contents of the cyst enter the pelvic cavity, which in women communicates with the abdominal cavity, causing peritonitis.

Cyst rupture often causes bleeding with extremely severe abdominal pain, tachycardia, and loss of consciousness.

The development of complications is an indication for emergency surgery.

Indications for removal.

Most often, functional cysts do not require surgical removal. They do not tend to malignancy, which means they do not carry cancer risks. Functional cysts go away on their own, or patients are prescribed hormonal therapy with oral contraceptives, which suspend the cycle, and the associated neoplasms are reduced. However, if conservative therapy is unsuccessful and is not suitable for any reason, the cyst is surgically removed.

Surgical treatment is indicated when any ovarian neoplasm is detected during menopause, conservative therapy is ineffective for more than 3 months, in the case of functional cysts and in the presence of a risk of malignancy. The development of any of the complications (suppuration, hemorrhage, rupture, torsion of the leg) is an indication for emergency surgery.

The volume of resection and the choice of access is determined individually together with the patient before the operation. Also, before the intervention, it is necessary to talk over the resection options that may be found when the malignancy of the neoplasm is detected.

Currently, most of the planned operations are performed using the laparoscopic approach, which reduces tissue trauma, the severity of pain and the time of rehabilitation.

How is the operation

Depending on the type of neoplasm, the surgeon chooses operational tactics. They begin with an audit of the pelvic organs – assess the condition of the tissues, the presence of effusion, and find a neoplasm. Examine its outer capsule and consistency. If an oncological process is suspected, resection of the ovary with histological examination during the operation is allowed.The pathologist gives his opinion on the malignancy or benignity of the neoplasm. Malignant tumors require more radical resection involving the fallopian tube, ovary, and omentum. In addition, when a malignant neoplasm is detected during the operation, washings are taken from the lateral canals of the abdominal cavity, subphrenic space, and the pelvic cavity for early detection of metastatic processes.

Cystectomy – removal of the cyst itself without capturing adjacent organs and structures.The neoplasm is carefully separated from the adjacent tissues. Accidental opening of the cyst and the outflow of its contents can lead to peritonitis. The removed material is placed in a special container. After extraction, the cyst is opened and carefully examined. Check the contents and walls of the capsule. In the presence of pathological inclusions and growths, an emergency histological examination is carried out. In some cases, it is required to excise not only the cystic formation itself, but also the adjacent organs. For this, adnexectomy is performed – removal of the uterine appendages.

Preparation for operation

Preparation begins with instrumental diagnostics – ultrasound (transvaginal and abdominal), Doppler ultrasound. If there is a suspicion of a common oncological process, an MRI or CT scan may be prescribed. Laboratory diagnostics are carried out, including a standard set of tests for infections, blood clotting and inflammatory markers. In some cases, blood donation for tumor markers is additionally prescribed. The volume of the intervention will depend on competent preparation and the results obtained.As with any other surgical intervention, food intake is limited the day before, and water is limited in the morning.

Rehabilitation period

After laparoscopy, the rehabilitation period is shorter than with traditional surgical interventions. The principle of early activation from the 1st day is applied. And the discharge is made already for 2-3 days. It is recommended to return to a full life without restrictions after 6-8 weeks. Until this time, it is worth adhering to a gentle regimen of physical activity and sexual rest.Throughout the year, you will need to undergo control examinations: ultrasound and bimanual examination.

Pregnancy after laparoscopy

By itself, the laparoscopic approach does not pose a risk for future pregnancy, since there is no trauma to the uterine epithelium. The preservation of reproductive function depends on the extent of the intervention. With the intact function of the ovaries and the integrity of the fallopian tubes, removal of the cyst does not carry risks associated with infertility.

90,000 Removal of an ovarian cyst (cystectomy) – the cost of the operation, the cost of treatment in a clinic in St. Petersburg

There are contraindications.Consultation of a specialist is required.

Ovarian cyst is a benign neoplasm. It is a bubble filled with liquid. Due to the cyst, the ovary enlarges, which leads to pain and other discomfort, and in some cases to infertility.

Causes and symptoms

No definite cause of the ovarian cyst has been identified. It is believed that the main risk factor for neoplasm is hormonal imbalance.The reasons for the violation of hormone production can be different:

• genetic predisposition;
• early puberty;
• late menopause;
• ovarian dysfunction;

90,067 abortions;

• diabetes mellitus.

Also, inflammation of the reproductive system and smoking can provoke the growth of a cyst.

Often, the disease proceeds without any symptoms, and is detected only during a gynecological examination.But in some cases, especially if the cyst is large, pain in the lower abdomen (moderate to severe) may be felt, menstrual irregularities, bloody discharge during the cycle, nausea, false urge to urinate and defecate may occur.

Ovarian cyst Medical center “CM-Clinic” offers services for the removal of ovarian cysts in women. We will quickly and professionally solve your problem. Sign up for a free consultation!

If you observe symptoms of an ovarian cyst, then immediately consult a gynecologist, as in the absence of treatment, this disorder can lead to serious complications.

Diagnostics and treatment

The diagnosis is always preceded by the collection of complaints, the study of the medical history, examination, laboratory and instrumental studies, including:

• analysis for the level of hormones;
• vaginal smear analysis;
• analysis for tumor markers;
• ultrasound.

According to the indications, other studies can be prescribed.

Laparoscopic method

General anesthesia

Operation time – 1-2 hours

Recovery in hospital – 1 day

Cost of surgery: from 40,000 rubles

Treatment tactics depend on the type and size of the cyst, as well as on the age, general health of the patient, the presence of concomitant diseases and contraindications.Currently, both conservative and surgical methods of treating ovarian cysts are used.

Conservative treatment of ovarian cysts is reduced to the normalization of the patient’s hormonal levels. For this, the doctor prescribes oral contraceptives. Multivitamins are prescribed to support the body.

If no improvement is observed within 2-3 months, then the woman is indicated for surgical treatment. In the medical center “CM-Clinic” several types of operations for ovarian cysts are performed: laparoscopic cystectomy (removal of the cyst), as well as oophorectomy (removal of the ovary), adnexectomy (removal of the uterine appendages).

Methods for removing ovarian cysts

The volume and tactics of the operation are determined on an individual basis. The doctor takes into account the general condition of the woman, diagnosis, comorbidities and other factors. Before surgical treatment, the patient undergoes an examination – tests, makes a chest x-ray, ECG, consults with a cardiologist, gynecologist, anesthesiologist, therapist.

An operation to remove an ovarian cyst is performed by laparoscopy or using classical surgical techniques.There are different types of interventions, in any case, the surgeon’s task is to take into account the woman’s reproductive plans and preserve the functions of the organs of the reproductive system.

Cystectomy

Carried out under general anesthesia. Access can be through an incision in the anterior abdominal wall or laparoscopically – three small punctures in the lower abdomen, through which carbon dioxide is first injected to provide a good view of the intervention area. Laparoscopy involves the use of endoscopic instruments and optics, which displays an image of internal structures on a monitor, with which the doctor controls the progress of the operation.

First, the cyst is excreted from the capsule. If the neoplasm is large, then its contents are aspirated first to reduce the risk of capsule rupture. When the tumor is removed, coagulation (cauterization) of the blood vessels is performed. The incision sites are sutured, the biomaterial is sent to the laboratory for histological analysis.

Depending on the clinical picture, surgeons try to carry out precisely laparoscopic interventions, because they are less traumatic, after which the patients recover quickly.In addition, doctors strive to preserve the functions of the reproductive organs of women. However, it happens that such a technique cannot be applied (if there is a risk of degeneration into cancer or the cyst is very large), and then other operations are performed:

• Ovariectomy – removal of the cyst together with the ovary. It is indicated for large formations and inflammation of the ovary.
• Removal of cysts and ovarian tissue to eliminate the risk of recurrence.
• Adnexectomy – removal of a neoplasm along with the uterine appendages (tubes and ovary).Can be single or double sided.

Endometrioid ovarian cysts

These are benign cavitary neoplasms from 5 to 20 cm, located inside the ovary or on its surface. Consist of accumulated menstrual blood, which is surrounded by a membrane of endometrial cells. With this disease, patients experience severe pain in the lower abdomen, they have heavy menstruation. The disease also threatens infertility. Almost always, it affects closely located internal organs – the bladder, ureter, etc.

Main reasons:

• history of abortion;
• sexually transmitted diseases;
• hereditary predisposition;
• previous uterine curettage;
• disrupted hormonal balance;
• long-term use of an intrauterine device;
• chronic inflammation of the reproductive organs;
• overweight;
• structural features of the cervical canal, due to which menstrual blood cannot flow freely;
• intimacy during menstruation.

Symptoms

Aching, dull pains in the lower abdomen, radiating to the perineum and rectum. The pain intensifies at the end of menstruation or after it, the menstruation itself is also painful, during intercourse there is significant discomfort. The pain syndrome increases with physical exertion, the body temperature can rise to 37.5 ℃, an increase in ESR and leukocytes is seen in the blood test.

With such a disease, an operation is indicated, in which the neoplasm is removed, and its bed is cauterized.The intervention has certain consequences – the risk of damage to healthy tissues, dysfunction of the ovary, the formation of adhesions, therefore, after removal of the endometrioid cyst, pregnancy may not occur.

If the endometrioid ovarian cyst is small, not only pregnancy, but also IVF is possible with it. It is possible to become pregnant with a large neoplasm, but it is a contraindication to natural childbirth, therefore, a planned cesarean section is performed.

In most cases, the surgeons of our clinic perform laparoscopic cyst removal, preserving the patient’s reproductive functions.

It should be remembered that this disorder is prone to relapse, therefore, even after removal of the ovarian cyst, a woman should regularly visit a gynecologist. There is no specific prevention of the disease.

Ovarian cyst is a common disease that affects many women. Often, it is only detected during examination, so it is extremely important to regularly visit your doctor. Make an appointment with the gynecologist “CM-Clinic” right now.

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You can recover and rest after the operation in a comfortable ward of a round-the-clock hospital. A doctor is on duty at the ward, who monitors the condition of the operated patients.

Removal of ovarian cysts by laparoscopic method in Moscow

Author

Petrova Evgeniya Yurievna

Leading physician

Gynecologist

Ovarian cyst is a thin-walled cavity filled with fluid.The cyst looks like a rounded bulge on the surface of the ovary. The sizes of cysts can vary from 3 to 20 and even 30 cm in diameter.

The cyst is usually asymptomatic and is often discovered accidentally during an ultrasound of the pelvic organs, performed routinely or for other reasons. Most cysts result from normal ovarian function. These cysts are called functional or follicular. They are benign lesions without a tendency to aggressive growth and usually go away on their own within a few months, gradually decreasing in size.

The revealed functional cyst is taken under dynamic observation and treated conservatively. If, within 3-4 months, conservative treatment does not give an effect (the cyst does not decrease), the issue of planned surgical treatment is resolved.

Learn more about ovarian cyst >>>

Indications for removal of the ovarian cyst

Urgent removal of the ovarian cyst is carried out with the development of complications:

• ruptured cyst;
• torsion of the cyst pedicle;
• formation of an inflammatory tumor as a result of cyst suppuration.

Such conditions are accompanied by pain in the lower abdomen, which can radiate to the legs or to the anus, weakness, dizziness, sometimes pre-fainting or fainting conditions, nausea and even vomiting, an increase in body temperature above 38 ° C, profuse bleeding from the genital tract. For such symptoms, an ambulance should be called.

The cyst is removed in routine :

• if the cyst is larger than 10 cm.;
• in case of suspicion of the possibility of malignant transformation. The assessment is given by the doctor on the basis of ultrasound data, depending on the age of the patient and the type of cyst. In postmenopausal women, the formation of a pathological cyst is more likely than a functional cyst. Therefore, in the postmenopausal period, the treatment of cysts is approached more radically.

Preparation for planned removal of the ovarian cyst

In preparation for the planned removal of the cyst, the following tests are required:

It is also necessary to undergo an ECG, pelvic ultrasound and consultation with an anesthesiologist.

Operation to remove the ovarian cyst

You can remove an ovarian cyst in Moscow in surgical hospitals of JSC “Family Doctor”.

Removal of an uncomplicated cyst is carried out, as a rule, by the laparoscopic method, through small incisions in the anterior abdominal wall. Three such incisions are made. Through one, an optical system is introduced, allowing the doctor to see what is happening in the operation area. The necessary surgical instruments are introduced through the other two.

Depending on the situation, the operation may consist of:

• in removing only the cyst itself, followed by coagulation of the wound surface of the ovary;
• in resection (removal of part) of the ovary;
• in the removal of the entire ovary.

The doctor’s efforts are always aimed at preserving the ovary as much as possible.

The operation is performed under full anesthesia. The planned operation time (taking into account anesthesia) is 3 hours.The duration of the operation itself, depending on the complexity of the case, is from 30 minutes to 1.5 hours. After the operation, the patient is admitted to a hospital. Typically, the hospital stay is 1–2 days. The stitches are usually removed on the 7th day. The recovery period and the period of disability during laparoscopic operations is minimal.

Do not self-medicate. Contact our specialists who will correctly diagnose and prescribe treatment.

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90,000 Laparoscopic surgery to remove ovarian tumors in Tula at the multidisciplinary clinic L-Med

Ovarian tumors are masses that grow from ovarian tissue.Ovarian tumors can be both benign (cystoma, fibroma, dermoid cyst, folliculoma and a number of others), and malignant – primary and secondary metastatic.

Benign ovarian tumors can exist for a long time without causing complications. But as practice shows, malignant neoplasms are often secondary and arise from benign ovarian tumors. Some complications of benign ovarian tumors may require immediate medical attention.Therefore, it is important to undergo timely diagnosis and treatment of an ovarian tumor.

There are risk factors that can lead to ovarian tumor:

• Hormonal disorders;
• Complicated heredity;
• Abortion;
• Presence of sexually transmitted diseases;
• Too early or late onset of sexual activity;
• Absence of pregnancy for a long time.

If you notice any risk factors leading to ovarian cancer, you should be more careful about your health.There are no obvious symptoms of an ovarian tumor. Sometimes a woman may feel pain in the lower abdomen that is not associated with menstruation, and sometimes it may not be. Only a doctor can diagnose ovarian tumors, who, after examination, prescribes a more thorough examination: ultrasound, blood test, computed tomography. Often, to clarify the diagnosis of an ovarian tumor, laparoscopy is indicated – an examination of the abdominal cavity using special optics. Laparoscopy makes it possible not only to carry out a complete diagnosis, but also to immediately remove the ovarian tumor.In the L-MED clinic, operations to remove ovarian tumors are performed ONLY for benign forms of the tumor. Treatment of a benign ovarian tumor is usually prompt.

Tumors of the ovary can reach enormous sizes, significantly increasing the size of the abdomen, or they can be asymptomatic for many years. Due to the possible malignancy (malignant transformation) and the development of life-threatening complications, the established diagnosis is an indication for surgical treatment of an ovarian tumor.

Depending on the type and size of the tumor, the removal of the ovarian tumor is performed; in older women, both ovaries are removed for prophylactic purposes, amputation of the uterus with appendages (the lower part of the uterus – the cervix is ​​left) or extended extrusion of the uterus with appendages and surrounding lymph nodes and tissue. The last operation is performed by open methods, the rest of the listed methods of treating ovarian tumors can be performed laparoscopically.

Laparoscopic surgery to remove ovarian tumor is easily tolerated by patients.The very next day you can get up, the pain is minimal. After treatment of the ovarian tumor, physical activity is restored within 1-2 weeks.

Treatment of an early stage ovarian tumor has the most favorable prognosis. Therefore, you should not delay the visit to the doctor and undergo regular preventive examinations.

Gynecology – Clinic Ekaterininskaya

Uterine myoma is a benign formation of muscle and connective tissue of the uterus.Today, a surgical method of treating a tumor is the most common. The volume of surgical intervention can be different – from the removal of one myomatous node to the complete removal of the uterus. For young women planning pregnancy in the future, our experienced obstetricians-gynecologists perform organ-preserving and reproductive surgeries.

MYOMECTOMY

In the course of this organ-preserving operation, only fibroids are removed. In our clinic, it is possible to perform myomectomy in several ways: laparoscopic, vaginal and laparotomy.

Laparoscopic myomectomy is the least traumatic method of surgical treatment. Removal of the neoplasm is performed through punctures in the anterior abdominal wall, after which there are no visible scars on the patient’s body.

MYOMECTOMY IN WOMEN PLANNING PREGNANCY AND CHILDBIRTH

The experience of our surgeons allowed them to formulate the principles for the most optimal choice of the method of surgical treatment of fibroids in women planning pregnancy and childbirth. Laparoscopic myomectomy is not suitable for such patients, since the area of ​​coagulation necrosis formed during this type of surgery prevents the formation of a durable scar on the uterus.An incompetent scar can lead to rupture of the uterus along the scar line after 16 weeks of gestation. If a woman is planning a pregnancy, then the most optimal method of surgery is laparotomic myomectomy, which allows a high-quality durable scar.

Myomectomy lasts 1 to 1.5 hours and is performed under general anesthesia. After the operation, the patient can recover under the round-the-clock supervision of doctors in the comfort of our hospital. As a rule, it takes from 3 to 5 days to stay within the walls of the clinic.The recovery period is approximately 2-3 weeks.

HYSTERECTOMY

Surgery to remove the uterus is performed in difficult cases of uterine tumors, ovarian tumors and in the treatment of severe endometriosis.

In our clinic, 2 types of hysterectomy are performed:

• amputation of the uterus with the possibility of preserving the cervix;
• Extirpation of the uterus with or without appendages.

The duration of such operations is from 1 to 2 hours.In a hospital, a woman usually spends no more than 5 days.

VAGINAL EXTRACTION OF THE UTERINE

Minimally invasive surgery to remove the uterus is performed through the dissection of the vaginal vaults, as well as in some cases using laparoscopic equipment.

If necessary, our surgeons can combine the operation to remove the uterus with simultaneous plastic surgery of the vagina and bladder, which will allow under one anesthesia to treat fibroids and stress urinary incontinence, as well as restore the location of the pelvic floor organs and eliminate developmental defects of the external genital organs of a woman.

Torsion of the ovarian cyst

Torsion of the ovarian cyst: causes, symptoms, diagnosis and treatment

Unfortunately, the female reproductive system is very susceptible to the formation of neoplasms, which is due to a significant number of factors, both external and internal nature, including genetic ones.

Tumor-like neoplasms include an ovarian cyst – a bubble with semi-liquid contents, which forms in the tissues of the ovary and thereby increases its volume.

Causes of torsion of the ovarian cyst

The risk of developing cystic neoplasms increases in women who have not given birth or, on the contrary, who often have resorted to artificial termination of pregnancy.

Often, ovarian cysts do not bother and are detected during preventive examinations.

At the same time, there may be painful sensations that intensify during intercourse.

Menstrual irregularities can manifest as dysfunctional uterine bleeding or delay.

A formidable complication of this disease is torsion, or kinking of the cyst leg, in which the pain becomes extremely intense, spreads throughout the abdomen, “shoots” into the rectum, accompanied by nausea and even vomiting.

Torsion can lead to necrosis, necrosis of the cyst tissue and, as a result, peritonitis, inflammation of the peritoneum – a deadly condition.

Thus, torsion of the ovarian cyst is an acute condition that requires immediate surgery.

Torsion of the cyst leg can occur as a result of sudden movements during sports or heavy household physical exertion, pregnancy or postpartum conditions, overflow of the bladder, increased intestinal motility, and trauma.

Types of torsion and its symptoms

The twist can be complete or partial.

With complete torsion, the following complex of symptoms can be observed:

• Acute, severe abdominal pain
• Drop in blood pressure
• Nausea, vomiting
• Urinary incontinence
• Diarrhea
• Tachycardia i.e. rapid heart rate
• Pallor of mucous membranes and skin
• Fainting

With incomplete torsion, the picture may not be so dramatic, but this can dull vigilance and the patient does not turn to specialists.Pains come and go. Especially such smoothed symptoms are typical for young patients or elderly women.

However, this condition is also unfavorable and requires examination by a gynecologist.

Diagnosis of cyst torsion

Ultrasound of the abdominal organs can reveal the presence of a cyst, its anatomical structure, size, and the degree of torsion of the leg.

If necessary, to clarify the diagnosis, diagnostic laparoscopy is prescribed, which allows, in addition to visual examination of the formation, to take tissue for histological examination.

Treatment of cyst torsion

Treatment, especially with full, developing rapidly developing torsion is only surgical.

Currently, advanced endoscopic organ-preserving technologies have been developed. Under the control of ultrasound, the gynecological surgeon straightens the torsion, thereby restoring the ovarian circulation and restoring its function. The cyst is removed.

If the cyst has reached a large size, the patient turned to specialists late, then the formation is removed through an incision in the abdominal wall.

Surgical interventions are carried out under anesthesia in a hospital setting.