Laparoscopic Management of Extremely Large Ovarian Cysts

Literature Review Article

Sagiv R, Golan A, Glezerman M. Laparoscopic Management of Extremely Large Ovarian Cysts. Obstet Gynecol 2005; 105:1319-1322. 

Review
Paul C. Lin, M.D., Seattle Reproductive Medicine

This article summarizes a retrospective observational study of a cohort of 21 patients from 2000-2003 who had large adnexal masses and low probability of malignancy and who were managed laparoscopically. Low probability was defined as no ascites, US and CT scans with features that were considered benign (absence of papillations, no intraperitoneal spread, no enlarged pelvic lymph nodes) and CA-125 <130 IU/L. Peritoneal washings were performed and frozen tissue sections were prepared during surgery. Aspiration, cystectomy or oopherectomy was performed as clinically indicated and removed via an endobag. One patient had mucinous adenocarcinoma and 20 others had benign pathology. Conversion to laparotomy to perform the necessary therapy for carcinoma is advocated when frozen section confirms a malignancy. The authors conclude that with proper patient selection, the size of the ovarian cyst is not a contraindication for laparoscopy.
 

Comments 
Daniel B. Williams, M.D., Cincinnati, OH

This small study demonstrated that large adnexal masses can be managed via laparoscopy. Most of the patients were premenopausal and there was only 1 case of malignancy, which is somewhat reassuring. All of the patients had to meet criteria that were consistent with a low probability of malignancy. The authors stress that it is mandatory to have an expert laparoscopist, as well as a gynecologic oncologist on call. Therefore, such procedures are not likely to be routinely performed by most gynecologists. 

 

The above review and commentary on this article were written by SRS members. Publication of these summaries does not reflect endorsement of any particular procedure or treatment. Views expressed in these summaries do not necessarily reflect the views of SRS or ASRM.

 

 

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