Ovarian Reserve Following Laparoscopic Ovarian Cystectomy vs Cyst Deroofing for Endometriomas

Study ObjectiveBecause laparoscopic ovarian cystectomy of endometriomas is known to adversely impact patient ovarian reserve, the search for other techniques of surgical management is ongoing. The present study was undertaken to evaluate laparoscopic cyst deroofing as a feasible alternative.Study DesignProspective, randomized clinical trial (Canadian Task Force classification I).SettingUniversity maternity hospital.PatientsWomen diagnosed with unilateral or bilateral ovarian endometriomas.InterventionsPatients were managed with either laparoscopic ovarian cystectomy or cyst deroofing.Measurements and Main ResultsA total of 122 women with endometriomas were randomized to either laparoscopic cystectomy (group 1) or laparoscopic cyst deroofing (group 2). The primary endpoint was the effect on ovarian reserve based on changes in anti-Müllerian hormone (AMH) values. At 1 month postsurgery, anti-Müllerian hormone values were significantly decreased (p < .001) from preoperative values, from 4.25 ± 0.87 ng/mL to 1.66 ± 1.02 ng/mL in group 1 and from 4.2 ± 1.69 ng/mL to 2.15 ± 1.48 ng/mL in group 2. In addition, antral follicle count and ovarian volume decreased significantly (p < .001) in both groups by 1 month postsurgery. The decreases in these 3 parameters were more significant (p < .001) in group 1 than in group 2.ConclusionLaparoscopic cyst deroofing of endometriomas appears to be a promising alternative to laparoscopic cystectomy, with less postoperative decrease in ovarian reserve; however, the higher rate of endometrioma recurrence warrants future clinical research to determine the optimal surgical management of endometriomas.     

术前使用GnRHa对腹腔镜巧克力囊肿切除手术质量的影响

目的:探讨术前使用促性腺激素释放激素激动剂对腹腔镜巧克力囊肿切除手术质量的影响.方法:回顾性分析64例腹腔镜巧克力囊肿切除手术资料,其中35例(研究组)术前3个月每月肌注促性腺激素释放激素激动剂3.75mg,其余29例(对照组)术前无药物治疗.结果:研究组、对照组的手术耗时、术中出血量、卵巢创面需电凝止血的例数、囊壁完...     

Homemade Glove Retrieval Bag in Laparoscopic Complete Excision of Benign Ovarian Teratoma with Ovarian Tissue Preservation in Children: A Case Series

Study ObjectiveTo present our experience of laparoscopic resection of pediatric benign ovarian teratomas with gonadal preservation, using a homemade glove retrieval bag.Design, Setting, Participants, Interventions, and Main Outcome MeasuresReview of all girls with benign ovarian teratomas who were managed with laparoscopic ovarian-sparing surgery (OSS) at our hospital between January 2013 and December 2018.ResultsEleven patients were included for analysis with a mean age of 6.1 years. Ten patients received elective surgery, whereas 1 patient received emergency surgery because of ovarian torsion. Main indication for OSS was the existence of a dissection plane between tumor margins and healthy ovarian tissue. Postoperative outcome and follow-up were uneventful with a median follow-up of 30.1 months (range; 12-60 months).ConclusionLaparoscopic OSS can be safely performed for these tumors. Laparoscopic magnification with energy devices are excellent tools in such procedures. The homemade glove bag can be used to retrieve the tumor effectively in countries with limited resources.     

Laparoendoscopic Single-Site Surgery for Treatment of Concomitant Ovarian Cystectomy and Cholecystectomy

Since the first laparoscopic appendectomy was performed by Semm in 1983, laparoscopic surgery has become the criterion standard surgical route for treatment of several pathologic conditions across disciplines. Attempts to minimize access-related injuries and complications resulted in development of laparoendoscopic single-site surgery (LESS), which, because of the decreased number of ports used, may be the next generation of minimally invasive surgery. Laparoscopic single-site surgery has been reported in nephrectomy, pyeloplasty, radical prostatectomy, cholecystectomy, and colorectal, bariatric, and gynecologic surgery. This technique may increase the benefits of traditional minimally invasive surgery such as decreased blood loss and postoperative pain, faster recovery time, fewer complications, and better cosmetic results, without increasing costs. Herein, we present a case report of single-port laparoscopic ovarian cystectomy and concomitant cholecystectomy performed with a multi-instrument access port (TriPort; Olympus America Inc., Center Valley, Pennsylvania). Single-port surgery eliminates the problem of multiple and different site placement for accessory ports, typical of these procedures when performed simultaneously at conventional laparoscopy.     

良性卵巢肿瘤术后对卵巢储备功能的影响

卵巢良性囊肿是育龄妇女常见的疾病,目前临床上常采用手术剥除为主,卵巢囊肿术后对卵巢功能的影响正日益受到关注,卵巢囊肿剔除或剥除手术,可减小卵巢体积,破坏卵巢血供,影响卵巢分泌性激素及排卵,甚至导致卵巢早衰。卵巢储备功能是评价卵巢囊肿术后的重要指标,具体包括卵巢体积、基础性激素、LH/FSH值等。针对卵巢囊肿手术治疗会对卵巢储备功能造成损害,本文将从卵巢囊肿疾病自身、卵巢囊肿手术及如何评估卵巢储备功能3个方面加以综述。     

The Safety of Laparoscopic Treatment for Ovarian Dermoid Tumours

Summary: Whilst laparoscopic surgery has largely replaced laparotomy as the standard surgical option for the management of benign ovarian cysts, concern remains regarding the safety of laparoscopy for benign cystic teratomas. This is based on a higher rate of cyst content spillage compared to laparotomy and the known sequelae of chemical peritonitis and granuloma formation. We present 18 cases of laparoscopic dermoid cystectomy with recommendations for specimen removal from the peritoneal cavity. Our findings together with evidence from the literature confirms the safety of laparoscopy for the treatment of ovarian dermoid cysts.     

The Safety of Laparoscopic Treatment for Ovarian Dermoid Tumours

Summary: Whilst laparoscopic surgery has largely replaced laparotomy as the standard surgical option for the management of benign ovarian cysts, concern remains regarding the safety of laparoscopy for benign cystic teratomas. This is based on a higher rate of cyst content spillage compared to laparotomy and the known sequelae of chemical peritonitis and granuloma formation. We present 18 cases of laparoscopic dermoid cystectomy with recommendations for specimen removal from the peritoneal cavity. Our findings together with evidence from the literature confirms the safety of laparoscopy for the treatment of ovarian dermoid cysts.     

One-Trocar,Video-Assisted Stripping Technique for Use in the Treatment of Large Ovarian Cysts in Infants

BackgroundManagement of ovarian cysts in infants is controversial; it can be conservative or surgical, and the management is determined by the cyst's size and sonographic features.MethodsA surgical approach using a 10-mm umbilically placed operative laparoscope was taken in 3 female infants with antenatally diagnosed large, simple ovarian cysts. The contents of the cysts were partially aspirated and the cyst walls were stripped off the remaining ovarian parenchyma. No intraoperative or postoperative complications were recorded.ConclusionsThe one-trocar video-assisted stripping technique for large ovarian cysts in infants appears to be an ovarian-tissue-preserving procedure, and it sidesteps the disadvantages of large scars and formation of adhesions.     

Laparoscopic Ovarian Transposition Before Pelvic Cancer Treatment: Ovarian Function and Fertility Preservation

Survivors of pelvic cancer treatment live with the ramifications of pelvic radiation for many years after their cure. Several options are available to preserve ovarian function and fertility in reproductive age women undergoing pelvic radiation. Laparoscopic ovarian transposition is an under-utilized, yet fairly simple surgical procedure to relocate the ovaries away from the radiation field. Although randomized-controlled trials on the outcomes of ovarian transposition are scarce, there is a growing body of evidence on the risks and benefits of this procedure, in terms of prevention of premature ovarian failure, and potentially preserving fertility. In this review, we summarize the available data on the indications, patient selection and outcomes of ovarian transposition, as well as illustrate the technique of the procedure.     

交界性卵巢肿瘤再分期手术11例临床分析

目的:探讨交界性卵巢肿瘤再分期手术的临床价值.方法:2006年1月至2010年12月在外院初次手术未全面分期而在我院接受再分期手术的交界性卵巢肿瘤患者共11例,平均年龄34.1岁,其中ⅠA期9例,ⅠB期2例;组织学类型:浆液性交界性肿瘤7例,黏液性交界性肿瘤3例,子宫内膜样交界性肿瘤1例.结果:经过再分期手术,4例患者分期提高,包括1例黏液性交界性卵巢肿瘤,1例子宫内膜样交界性卵巢肿瘤和2例浆液性交界性卵巢肿瘤.初次手术残留肿瘤的部位为对侧卵巢1例,腹腔冲洗液中3例发现肿瘤细胞(其中1例初次手术为腹腔镜术中肿瘤破裂).再分期术后随访至今,共随访18 ～ 70个月,平均随访时间42.6个月,分期未改变的7例患者和分期提高的4例患者均无复发.结论:对于交界性卵巢肿瘤,是否再分期手术需结合患者初次手术探查的彻底性、肿瘤的组织学亚型和患者的观点综合考虑,再分期手术对于浆液性肿瘤患者可能有益.     

腹腔镜手术治疗宫内外同时妊娠21例临床分析

目的:评估腹腔镜手术在宫内外同时妊娠(HP)诊断和治疗中的价值,探讨对HP患者实施腹腔镜手术的手术技巧。方法:回顾性分析2003～2010年在我院接受腹腔镜手术治疗的21例HP患者的临床资料。结果:21例患者中有20例为输卵管妊娠(均行患侧输卵管切除术),1例为宫角妊娠(行宫角妊娠取出术)。部分患者同时行盆腔粘连松解术和(或)对侧输卵管结扎术。所有手术均经腹腔镜顺利完成,无中转开腹,无术中重大并发症发生。术后有20例患者接受不同时间的保胎治疗,17例成功分娩,1例怀孕8个月,2例保胎失败,保胎成功率达90.0%(18/20)。结论:腹腔镜手术不仅可早期确诊可疑HP患者,减少异位妊娠对宫内胚胎的影响,还可同时对异位妊娠进行有效治疗,对休克型及少见的HP的治疗亦安全可行。腹腔镜手术是治疗HP的理想手术方式。     

两种手术治疗卵巢良性肿瘤80例对比分析

目的:探讨应用腹腔镜手术治疗卵巢良性肿瘤的疗效。方法:将80例卵巢良性肿瘤患者,分别行腹腔镜手术(腹腔镜组)和开腹手术(开腹组),观察两组手术效果及手术并发症。结果:腹腔镜组手术时间与开腹组比较差异无显著性(P>0.05)。腹腔镜组术中出血量、肛门排气时间、术后平均住院日及术后发热、感染、镇痛剂使用例数均明显少于开腹组(P<0.01)。结论:腹腔镜手术对机体内外环境干扰少,术中出血量少,术后恢复快,适于临床应用。