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.     

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.     

Total Laparoscopic Hysterectomy: 10 Steps Toward a Successful Procedure

Vaginal and laparoscopic hysterectomies have been clearly associated with decreased blood loss, shorter hospital stay, speedier return to normal activities, and fewer abdominal wall infections when compared with abdominal hysterectomies. In this review, the authors outline the 10 steps to a successful laparoscopic hysterectomy.Key words: Total laparoscopic hysterectomy, Laparoscopic supracervical hysterectomy, Minimally invasive gynecological procedureHysterectomy is one of the most commonly performed surgical procedures in the United States, with 570,000 cases performed in 2006.¹ Vaginal hysterectomies have been performed successfully for almost 2 centuries, and more recently Reich and colleagues² introduced the laparoscopic hysterectomy. However, despite the advent of these minimally invasive procedures, abdominal hysterectomy remains the most common surgical approach, with well over half of hysterectomies being performed via a laparotomy.³Vaginal and laparoscopic hysterectomies have been clearly associated with decreased blood loss, shorter hospital stay, speedier return to normal activities, and fewer abdominal wall infections when compared with abdominal hysterectomies.^4–6 In light of these findings, a recent review concluded that vaginal hysterectomy is preferable to abdominal hysterectomy and that a laparoscopic hysterectomy should be attempted when vaginal hysterectomy is not possible.⁶ The vaginal approach is less expensive, but may be challenging in patients with a history of an adnexal mass, endometriosis, pelvic pain, and prior abdominal surgery, or in patients with a narrow pubic arch or poor vaginal descent.The relatively slow adaptation of laparoscopic hysterectomy may in part be attributed to inadequate exposure and training during residency.⁷ In addition, a number of provider barriers have been identified, including insufficient experience and training, lack of hospital equipment, and inadequate support from colleagues. Relatively low reimbursement rates may also curb provider enthusiasm for additional training and incorporation of the laparoscopic hysterectomy into their surgical armamentarium.⁸     

Laparoscopic Cystectomy for the Treatment of Benign Ovarian Cysts in Children: An Analysis of 21 Cases

Study ObjectiveTo evaluate the outcomes of treatment with minimal invasive surgery in children with benign ovarian cysts.DesignRetrospective chart review.SettingsMaternity and children hospital.PatientsBetween May 2007 and May 2011, 21 children were treated by laparoscopic method for ovarian cysts at our clinic. The age, symptoms, ultrasonographic findings, operation records and follow-up times were retrospectively evaluated.ResultsThe mean age was 13.2 years. One patient presented with findings of torsion and another presented with findings of rupture; both were urgently operated on. The other patients presented with intermittent abdominal pain and were operated on under elective basis. The mean cyst size was 8.4 cm (5-13 cm). One patient with necrotic ovary and salpinx due to torsion underwent salpingo-oophorectomy while the others were administered ovary-preserving cystectomy. Only 4 patients required iv paracetamol as an analgesic in the postoperative period. Two patients were discharged on the second postoperative day while the remaining 19 patients were discharged on the first postoperative day. During a mean follow-up of 14 months, no recurrence was seen in this period. Cosmetic appearance was good in all patients.ConclusionThe authors demonstrated that laparoscopic cystectomy was a technically feasible and safe method in the treatment of benign ovarian cysts, associated with short hospitalization, minimal analgesic requirement, and a good cosmetic appearance.     

Virilizing Ovarian Dermoid Cyst with Leydig Cells

BackgroundThe clinical observation of virilization is a rare finding that has a number of possible explanations. Overall, ovarian tumors causing virilization are exceedingly rare and mostly occur in post-menopausal women. In fact, there are no reported cases of virilization from a testosterone-producing ovarian dermoid in the adolescent female age group. The most frequent germ cell tumor derived from the ovaries is the benign cystic teratoma (dermoid) which accounts for 25% of all ovarian neoplasms.¹ Teratomas consist of tissues that recapitulate the ectoderm, endoderm, and mesoderm. Usually the tumors are asymptomatic, but they occasionally can cause severe pain if there is torsion or if sebaceous material perforates the cyst wall, leading to reactive peritonitis.¹CaseA 12-year-old female was found to have a large 3 5× 19 × 12 cm ovarian mature cystic teratoma arising from her right ovary. The patient also displayed evidence of masculinization demonstrated by a deepening voice and clitoromegaly. The dermoid was producing large amounts of testosterone from a nest of Leydig cells found pathologically in the mass.ConclusionBenign cystic teratomas can produce active hormones, albeit rarely. This is a finding important to consider when ovarian cystectomy is performed for removal of a benign cystic teratoma.     

Laparoscopic Removal of Dermoid Cysts Using Endopouch

EDITORIAL COMMENTS: We accepted this paper for publication since like other articles in this issue, it describes another laparoscopic technique available to the gynaecologist. However, reviewers of this paper wish to remind readers that cystic teratomas are often too large for this retrieval bag technique (> 7cm) and more importantly that the standard operation for cystic teratomas in premenopausal women is ovarian cystectomy with preservation of the ovary and ovarian function. In our experience enucleation of a cystic teratoma with conservation of the ovary is always possible unless the tumour has undergone torsion and is necrotic. Moreover, enucleation of an ovarian cyst can be performed by laparoscopic technique (A).
A. Wood C, Maher P, Hill D. Gynaecological endoscopy. RACOG continuing education Resource Unit 100, 1993.
Summary: Laparoscopic oophorectomy was successfully performed in 6 patients with ovarian dermoid cysts. The use of Endopouch eliminates the risk of spillage and the need to extend the wound. The duration of operation ranged from 60 to 90 minutes and all patients were discharged within 48 hours with minimal pain and no complications.     

卵巢及输卵管手术对卵巢反应性的影响

目的:探讨卵巢肿瘤剔除术,输卵管手术对卵巢功能的影响。方法:以曾做卵巢肿瘤剔除术、输卵管妊娠行输卵管手术者为实验组,输卵管阻塞性不孕患者为对照组,回顾性分析两组因不孕行体外受精-胚胎移植患者的卵巢对控制性超排卵的反应。结果:实验组窦卵泡数,hCG日直径≥14mm、<14 mm的卵泡数,取卵数均明显少于对照组,促性腺激素(FSH)用量明显多于对照组;卵巢肿瘤剔除术组hCG日直径≥14 mm的卵泡数、取卵数明显少于输卵管切除术组和输卵管修补组;输卵管切除术组hCG日直径≥14 mm,<14 mm的卵泡数,取卵数均明显少于输卵管修补术组。三实验组术侧卵巢对比,卵巢肿瘤剔除术组除各项参数均明显低于输卵管切除术组及输卵管修补术组。结论:卵巢及输卵管手术均影响卵巢功能,减低卵巢储备能力,手术范围越大,损伤越大。     

Laparoscopic Management of an Ovarian Dermoid Cyst Containing a Mandibular Structure with Teeth: A Novel Surgical Approach

BackgroundThe presence of ectodermal-derived tissue, including teeth, in an ovarian dermoid cyst is a common occurrence. The presence of a fully formed mandibular structure with teeth, however, is rare, and there are few case reports in the literature that discuss its surgical management.CaseWe report a case of an adolescent girl found to have a mandibular structure with teeth in her dermoid cyst at the time of her laparoscopic ovarian cystectomy and a novel surgical approach in the extraction of the cyst contents from the abdominal cavity.Summary and ConclusionThe use of an arthroscopic surgical blade to morcellate the mandibular-like bone allowed for completion of the procedure laparoscopically, without laparotomy for specimen extraction, allowing the patient to benefit from the advantages of minimally invasive surgery.     

Unilateral Ovarian Dermoid Cyst Accompanied by an Ipsilateral Paratubal Cyst in a Girl with Proteus Syndrome Discovered by Laparoscopic Surgery

BackgroundProteus syndrome is a rare hamartomatous disorder characterized by the overgrowth of multiple tissues in a mosaic pattern. Tumors of genitourinary tract in Proteus syndrome are uncommon.CaseWe here report a 5-year-old girl with Proteus syndrome who developed a cystic mass in the pelvic cavity. The cyst was discovered by ultrasonographic examination and finally proved to be a unilateral ovarian dermoid cyst accompanied by an ipsilateral paratubal cyst by laparoscopic surgery.Summary and ConclusionProteus syndrome accompanied by an ovarian cyst is rare in girls. The possibilities of underlying ovarian cyst required for surgical intervention should be considered in Proteus syndrome.     

Ovarian Dermoid Cyst Leakage — A Cautionary Tale

Summary: This case illustrates that when a dermoid cyst is punctured, an immediate operative laparoscopy or laparotomy should be performed, along with lavage, to avoid the problems associated with dermoid cyst contents spillage.