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Kanneganti A, Bhadiraju P, Tong PSY. Extragonadal teratomas in women and adolescent girls: A systematic review. Eur J Obstet Gynecol Reprod Biol 2021; 262:134-141. [PMID: 34022590 DOI: 10.1016/j.ejogrb.2021.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/10/2021] [Accepted: 05/02/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Extragonadal teratomas (EGTs) are rare and the commonest intra-abdominal subtype is omental. We present two cases: 1) a parasitic omental teratoma likely secondary to auto-amputation of an ovarian teratoma with subsequent omental reimplantation and 2) an omental immature teratoma likely due to parthenogenetic activation of displaced primordial germ cells. We subsequently conduct a systematic review to characterise EGTs. METHODS We sourced for English, peer-reviewed case reports of extragonadal teratomas in women and female adolescents aged 11 and above published from inception of each database through 31st June 2020 following PRISMA guidelines. Two authors reviewed each case for appropriateness and each case was graded for methodological quality utilising a modified Newcastle Ottawa Scale. PROSPERO Registration Number: CRD42020190131 RESULTS: Upon literature review between 1920-2020, from an initial screen of 818 articles, 67 articles were selected featuring 70 cases. One case featured an immature teratoma while the remaining were mature. Omental EGTs were the most common (56.5 %) followed by Pouch of Douglas and uterosacral ligament (23.2 %) and upper abdomen (14.5 %). There were statistically significant differences in EGT mean sizes between each location with the largest being in the upper abdomen (10.9 cm) and the smallest being in the adnexa or hernia (6.2 cm). Auto-amputation was deemed the commonest cause amongst omental EGTs (55.3 %) and Pouch of Douglas and uterosacral ligament EGTs (37.5 %) while 70 % of upper abdominal EGTs were likely due to displaced primordial germ cells. We characterise clinical features associated with each pathogenic mechanism and imaging characteristics of EGTs. Characterisation of EGT tumour marker profiles was limited as only 42.9 % of cases reported them but 19.2-25.0 % had raised tumour markers. The main risks are torsion, rupture, immature components and potential malignant change of the cell lines. Treatment is largely surgical. The mean size of EGTs approached laparoscopically and via laparotomy was 5.23 cm and 9.16 cm respectively. CONCLUSIONS While rare, EGTs should be considered when evaluating pelviabdominal masses with imaging characteristics consistent with teratomas. Confirmation is usually intraoperative and a laparoscopic approach is reasonable if there is good surgeon comfort and the size is about 5 cm.
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Affiliation(s)
- Abhiram Kanneganti
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Ridge Road, 119074, Singapore
| | - Poornima Bhadiraju
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Ridge Road, 119074, Singapore
| | - Pearl Shuang Ye Tong
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Ridge Road, 119074, Singapore.
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Iavazzo C, Vorgias G, Iavazzo PE, Gkegkes ID. Fertility sparing approach as the standard of care in young patients with immature teratomas. J Turk Ger Gynecol Assoc 2017; 18:43-47. [PMID: 28506950 PMCID: PMC5450210 DOI: 10.4274/jtgga.2016.0090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Immature teratomas are quite rare tumors arising in young women. They are usually diagnosed in early stage and grade and have a good prognosis. In these young patients, fertility-sparing management is suggested as the standard of care. Bilateral immature teratoma is a rare condition with an incidence of 10%, with a five-year survival rate of 80%. The majority of patients received fertility-sparing treatment followed by adjuvant chemotherapy in 78%. Older age, advanced stage, and high grade are negative prognostic factors. The surgery-only, watch-and-wait approach was evaluated; however, after a median follow-up time of 42 months, 50% of patients experienced recurrence, but they were successfully salvaged with chemotherapy. In a retrospective study, 12 out of 27 patients tried to conceive, resulting in 10 pregnancies (8 after chemotherapy). We present a narrative review of the current literature regarding the essential multidisciplinary approach of such patients in order to achieve the best oncologic and fertility-sparing outcome.
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Affiliation(s)
- Christos Iavazzo
- Department of Gynecological Oncology, Christie Hospital, Manchester, United Kingdom
| | - George Vorgias
- Department of Gynecological Oncology, Metaxa Cancer Hospital, Piraeus, Greece
| | | | - Ioannis D Gkegkes
- First Department of Surgery, General Hospital of Attica "KAT", Athens, Greece
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Lim JHC, Lim GHC, Lim JHY, Douliotis I, Athanasias P. Chemical peritonitis in pregnancy: An unusual presentation and review of the literature. J OBSTET GYNAECOL 2016; 36:496-7. [PMID: 26789232 DOI: 10.3109/01443615.2015.1094039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jessica Hui Cheah Lim
- a Department of Obstetrics & Gynecology , Epsom and St Helier University Hospital NHS Trusts , London , UK and
| | | | - Joanne Hui Yee Lim
- a Department of Obstetrics & Gynecology , Epsom and St Helier University Hospital NHS Trusts , London , UK and
| | - Ioannis Douliotis
- a Department of Obstetrics & Gynecology , Epsom and St Helier University Hospital NHS Trusts , London , UK and
| | - Pandelis Athanasias
- a Department of Obstetrics & Gynecology , Epsom and St Helier University Hospital NHS Trusts , London , UK and
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Lim J, Lim G, Lim JY, Athanasias P, Doulotis I. WITHDRAWN: Rare occurrence of chemical peritonitis: A case report of laparoscopic management of ruptured dermoid cyst in pregnancy and the literature review. Int J Surg Case Rep 2014. [DOI: 10.1016/j.ijscr.2014.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Miyauchi Y, Matsubara H, Uchida T, Matsuoka H, Ichihara T, Matsumoto M. Successful thoracoscopic removal of a giant teratoma following extraction of cystic conponents: a case report. Asian J Endosc Surg 2014; 7:79-81. [PMID: 24450351 DOI: 10.1111/ases.12067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 09/02/2013] [Accepted: 09/05/2013] [Indexed: 11/29/2022]
Abstract
Video-assisted thoracoscopic surgery is a type of minimal-access surgery. The nature of the surgery means that there are limitations on the size of a tumor that can be removed through an access incision. Herein, we report our experience removing a giant teratoma (16 × 14 × 13 cm in size) from the anterior mediastinum of a young girl. We employed video-assisted thoracoscopic surgery to remove the teratoma through a mini-thoracotomy following the extraction of the cystic components.
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Affiliation(s)
- Yoshihiro Miyauchi
- Department of Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
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Jahan S, Mahmud N, Mondal SK, Das T, Akter N, Nahar S, Habib SH, Saha S. Laparoscopic Surgery for Large Benign Ovarian Cysts: Experience in a Tertiary Care Hospital in Bangladesh. J Gynecol Surg 2011. [DOI: 10.1089/gyn.2010.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Samsad Jahan
- Department of Gynaecology and Obstetrics, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) Hospital, Dhaka, Bangladesh
| | - Nusrat Mahmud
- Centre for Assisted Reproduction, BIRDEM Hospital, Dhaka, Bangladesh
| | - Samiron K. Mondal
- Department of General & Colorectal Surgery, BIRDEM Hospital, Dhaka, Bangladesh
| | - Tripti Das
- Department of Gynecology & Obstetrics, Bangladesh College of Physicians and Surgeons, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Nargis Akter
- Department of Gynecology & Obstetrics, Bangladesh College of Physicians and Surgeons, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Samsun Nahar
- Department of Gynaecology and Obstetrics, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) Hospital, Dhaka, Bangladesh
| | - Samira H. Habib
- Health Economics Unit, Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | - Soma Saha
- Health Economics Unit, Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
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Hernon M, McKenna J, Busby G, Sanders C, Garden A. The histology and management of ovarian cysts found in children and adolescents presenting to a children’s hospital from 1991 to 2007: a call for more paediatric gynaecologists. BJOG 2009; 117:181-4. [DOI: 10.1111/j.1471-0528.2009.02433.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Savasi I, Lacy JA, Gerstle JT, Stephens D, Kives S, Allen L. Management of ovarian dermoid cysts in the pediatric and adolescent population. J Pediatr Adolesc Gynecol 2009; 22:360-4. [PMID: 19589709 DOI: 10.1016/j.jpag.2008.12.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2008] [Revised: 11/26/2008] [Accepted: 12/09/2008] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE To evaluate the surgical approach used in the management of ovarian dermoid cysts in the pediatric and adolescent population. DESIGN A descriptive retrospective chart review of all cases of ovarian dermoid cyst excision between January 2001 and January 2006. SETTING The Hospital for Sick Children, Toronto, Canada. PARTICIPANTS Forty-one female children and adolescents who underwent operative management of an ovarian dermoid cyst. MAIN OUTCOME MEASURES Surgical approach (laparoscopy vs laparotomy), intraoperative cyst rupture, length of hospital stay, and postoperative complications. RESULTS The mean age was 12.5 years. All cysts were unilateral. Twenty-three patients (56%) underwent laparoscopic cystectomy, 14 (34%) underwent cystectomy via laparotomy, and 4 (10%) oophorectomies were performed via laparotomy. Cyst size was significantly larger in the laparotomy group compared to the laparoscopy group (mean diameter 14.4 cm vs 7.1 cm, respectively, P < .001). A significantly higher rate of cyst rupture was experienced during laparoscopic cystectomy (100%), compared to excision via laparotomy (27.7%, P < .001). Length of hospital stay was significantly shorter in the laparoscopy group compared to the laparotomy group (median of 0 vs 3 days, respectively, P < .001). A single case in the laparoscopy group sustained a bladder injury and developed postoperative necrotizing fasciitis resulting in a prolonged hospitalization and recovery. There were no operative or postoperative complications related to cyst content spillage, regardless of the surgical approach. CONCLUSION Laparoscopic cystectomy is a safe and effective method of managing ovarian dermoid cysts in the pediatric and adolescent patient population.
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Affiliation(s)
- Ingrid Savasi
- University of Toronto, Hospital for Sick Children, Toronto, Canada
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Chen RJ, Chen KY, Chang TC, Sheu BC, Chow SN, Huang SC. Prognosis and treatment of squamous cell carcinoma from a mature cystic teratoma of the ovary. J Formos Med Assoc 2009; 107:857-68. [PMID: 18971155 DOI: 10.1016/s0929-6646(08)60202-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND/PURPOSE Squamous cell carcinoma (SCC) arising from a mature cystic teratoma of the ovary is rare and only reported sporadically. Clinical information on the disease is limited. This study assesses the clinical characteristics, treatment, outcome and prognostic factors of reported cases. METHODS Two hundred and twenty cases from 1976 through to 2005 in MEDLINE were analyzed for patient age, clinical and laboratory data, extent of disease, tumor markers, treatment and survival rates. Only the 188 cases with surgical staging were included in the survival analysis. RESULTS The disease occurred most often in elderly women (mean, 55.0 +/- 14.4 years) and cysts were large (mean, 13.7 +/- 5.7 cm). Abdominal pain (71.6%) was the most common symptom. Preoperative serum SCC antigen level had a high positive rate (81.3%). Overall 5-year survival rate for all stages was 48.4%. For Stage I, the 5-year survival rate was 75.7%; stage II, 33.8%; stage III, 20.6%; and stage IV, 0% (p < 0.0001). Univariate analysis revealed that tumor stage, patient age, tumor size, preoperative SCC antigen and CA125 levels, and optimal debulking were significant prognostic factors. Further investigation into treatments for all stages revealed that postoperative adjuvant chemotherapy may produce a better survival rate for both stage III and stage IV cases. However, postoperative radiotherapy did not show a similar effect. Multivariate analysis indicated that stage and optimal debulking were significant factors that influenced survival. CONCLUSION A mature cystic teratoma should be treated as early as possible. Tumor stage and optimal debulking are critical to survival. Unlike SCCs of the uterine cervix, postoperative adjuvant chemotherapy may produce a better result than adjuvant radiotherapy for advanced-stage cases.
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Affiliation(s)
- Ruey-Jien Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Yazbek J, Helmy S, Ben-Nagi J, Holland T, Sawyer E, Jurkovic D. Value of preoperative ultrasound examination in the selection of women with adnexal masses for laparoscopic surgery. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 30:883-888. [PMID: 17932999 DOI: 10.1002/uog.5169] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To assess the value of preoperative ultrasound examination in predicting the feasibility of intermediate-level laparoscopic surgery for benign adnexal masses. METHODS Symptomatic women with a clinical or ultrasound diagnosis of adnexal mass were offered a detailed transvaginal ultrasound scan in order to assess the feasibility of laparoscopic cystectomy/oophorectomy. In all cases an attempt was made to establish a likely histological diagnosis using the pattern recognition method. The selection criteria for laparoscopic surgery were: no ultrasound features suggestive of ovarian cancer, predominantly cystic lesion with no solid foci > 5 cm in mean diameter, no evidence of severe pelvic endometriosis or severe pelvic adhesions and dermoid cyst < 10 cm in mean diameter. Laparoscopic surgery was classified as successful if the mass was removed completely without resorting to a laparotomy. RESULTS One hundred and forty-three women were diagnosed with a total of 162 adnexal cysts. The final dataset consisted of 137 women (with 153 lesions), 113 (82.5%) of whom were selected for laparoscopy and 24 (17.5%) for laparotomy. On histological examination 152 (99.3%) cysts were benign and the remaining one (0.7%) was borderline. The operation was successfully completed laparoscopically in 107/113 (94.7%) cases. The preoperative ultrasound assessment predicted the successful outcome of laparoscopic surgery with a sensitivity of 98% (95% CI, 94-99%), specificity of 79% (95% CI, 60-90%), positive predictive value of 95% (95% CI, 89-98%), positive likelihood ratio of 4.58 (95% CI, 2.25-9.32) and negative likelihood ratio of 0.02 (95% CI, 0.01-0.09). CONCLUSIONS A detailed preoperative transvaginal ultrasound examination is a helpful tool for assessing the feasibility of intermediate-level laparoscopic surgery in women with benign adnexal lesions.
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Affiliation(s)
- J Yazbek
- Early Pregnancy and Gynaecology Assessment Unit, King's College Hospital, London, UK.
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Rubod C, Triboulet JP, Vinatier D. [Ovarian dermoid cyst complicated by chemical peritonitis. Case report]. ACTA ACUST UNITED AC 2007; 35:651-3. [PMID: 17602847 DOI: 10.1016/j.gyobfe.2006.12.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Accepted: 12/21/2006] [Indexed: 11/27/2022]
Abstract
Dermoid cyst is the most frequent benign ovarian tumor. Its spontaneous or more frequently iatrogenic intraperitoneal rupture may lead to a chemical peritonitis. This is a rare complication but with a potentially dangerous issue. We report a case of a patient who developed chemical peritonitis after laparoscopic management of ovarian dermoid cysts. Three further interventions, associated with systemic anti-inflammatory treatment, were necessary to resolve symptoms completely. On the basis of this case, we aim to re-access the characteristics of dermoid cysts and highlight in particular the potential complication of chemical peritonitis and the following attitude to avoid this.
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Affiliation(s)
- C Rubod
- Service de Gynécologie Chirurgicale, Hôpital Jeanne-de-Flandre, CHRU de Lille, 2 Avenue Oscar-Lambret, 59037 Lille cedex, France
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Wen KC, Hu WM, Twu NF, Chen P, Wang PH. Poor prognosis of intraoperative rupture of mature cystic teratoma with malignant transformation. Taiwan J Obstet Gynecol 2007; 45:253-6. [PMID: 17175475 DOI: 10.1016/s1028-4559(09)60236-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To present the phenomenon of the postoperative rapid progression of mature cystic teratoma (MCT) with malignant transformation (MT) when intraoperative spillage occurs during operation. CASE REPORTS Two patients with MCT were treated, one with total hysterectomy plus bilateral salpingo-oophorectomy in an exploratory laparotomy, and the other with cystectomy with laparoscopy, respectively. Tumor spillage occurred during both operations. The postoperative pathology showed MCT with MT (squamous cell carcinoma type). Both patients were referred to our hospital and underwent treatment (3 months and 8 days, respectively, after the initial operation). At the secondary laparotomy for staging surgery, tumor dissemination was observed in both patients. CONCLUSION Whether or not tumor dissemination is correlated with tumor rupture during operation, we emphasize that any patient with a preoperative diagnosis of MCT should have it removed intact to avoid the possibly catastrophic event of tumor dissemination.
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Affiliation(s)
- Kuo-Chang Wen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, and Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan
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Laberge PY, Levesque S. Short-Term Morbidity and Long-TermRecurrence Rate of Ovarian Dermoid CystsTreated by Laparoscopy Versus Laparotomy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2006; 28:789-793. [PMID: 17022919 DOI: 10.1016/s1701-2163(16)32253-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the short-term morbidity and the long-term recurrence rate of ovarian dermoid cysts in women treated conservatively by laparoscopy with the outcomes in women treated by laparotomy. METHODS This retrospective multicentre cohort study compared the outcomes of removal of dermoid cysts by laparoscopy with removal by laparotomy. All specimens were confirmed histologically as dermoid cysts. We reviewed all medical records and identified all surgical interventions for dermoid cysts over a 10-year period (1993-2003) in two academic centres in Quebec City. Of the 299 women treated for ovarian dermoid cysts, 167 were treated by laparotomy and 132 were treated by laparoscopy. To compare short-term morbidity, we excluded those who had undergone ophorectomy or any concomitant surgery, and we consequently reviewed the records of 98 patients in the laparotomy group and 100 patients in the laparoscopy group. To compare long-term recurrence rates we excluded only those patients who had had oophorectomy. In total, 245 women with available follow-up were identified as having ovarian cystectomy (95 in the laparoscopy group and 150 in the laparotomy group). Two-tailed Fisher exact test was used for analysis of categorical variables, and Student t test or Wilcoxon rank test were used for analysis of continuous variables comparing the two groups. Life table analysis using the Kaplan-Meier method was performed to assess the risk of long-term recurrence. RESULTS The mean diameter of the cyst in women who had a laparotomy was significantly larger than in women who had laparoscopy (8.27 cm vs. 5.94 cm), and significantly more women in the laparotomy group had bilateral cysts (16% vs. 5% in the laparoscopy group). In women who had laparoscopy, operating time was greater (P = 0.0363), but blood loss was less (P < 0.0001) and duration of hospital stay (P < 0.0001) was shorter. Spillage of the cyst's contents occurred in 18% of cases in the laparoscopy group and in 1% in the laparotomy group. Conversions of laparoscopy to laparotomy occurred in 11% of cases, mainly because of cyst size. Postoperative complication rates were similar in the two groups. Reintervention rate was 4.2% in the laparoscopy group and 0% in the laparotomy group (P = 0.0217). Using life table analysis, the probability of recurrence at two years was 7.6% (95% confidence intervals 2.9, 19.2) in the laparoscopy group and 0% in the laparotomy group. CONCLUSION Ovarian cystectomy performed by laparoscopy is associated with a higher incidence of intra-abdominal spillage than laparotomy, but this not associated with any increase in morbidity. Laparoscopic treatment results in a shorter hospital stay and less intraoperative blood loss than laparotomy, but it is associated with a significantly higher risk of recurrence.
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Affiliation(s)
- Philippe Y Laberge
- Department of Obstetrics and Gynaecology, Laval University Hospital Centre (CHUL), Laval University, Quebec City QC
| | - Stephanie Levesque
- Department of Obstetrics and Gynecology, Centre Hospitalier Régional de Rimouski (Québec)
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Koçak M, Dilbaz B, Ozturk N, Dede S, Altay M, Dilbaz S, Haberal A. Laparoscopic management of ovarian dermoid cysts: a review of 47 cases. Ann Saudi Med 2004; 24:357-60. [PMID: 15573848 PMCID: PMC6148138 DOI: 10.5144/0256-4947.2004.357] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Mature cystic teratomas, often referred to as dermoid cysts, are the most common germ cell tumors of the ovary. In the recent years, transvaginal sonographic diagnosis of ovarian dermoid cysts together with laparoscopic approach have greatly improved the treatment of this benign lesion. We retrospectively reviewed the outcome of laparoscopic surgery for suspected ovarian dermoid cysts. PATIENTS AND METHODS The preoperative findings, operative techniques and postoperative complications were retrospectively reviewed in women who underwent laparoscopic surgery for dermoid cysts, between January 2000 and May 2003. RESULTS In 47 women aged 21 to 53 years (median, 38.8 years), 93.6% had a unilateral cyst with a diameter of 17 to 108 mm (median, 51 mm). Clinical presentations were pain (62%), abnormal vaginal bleeding (21%) and ovarian torsion (2%), whilst 17% were diagnosed incidentally during routine examination. Surgery included cystectomy (57%), total (36%) or partial oophorectomy (6.4%) and laparoscopy-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy (2%). During the cyst extraction, minimal spillage occurred in 42.5% of the cases and none developed chemical peritonitis. In 2 patients, conversion to laparotomy (4.3%) was required, one for sigmoid colon injury and one for malignant ovarian tumor detected via frozen section. The median operating time was 80 minutes (range, 35-180 minutes). CONCLUSION Using strict adherence to guidelines for preoperative clinical assessment and intra-operative management, laparoscopic treatment of dermoid cysts appears to be a safe procedure.
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Affiliation(s)
- Muberra Koçak
- Department of Obstetrics, SSK Maternity and Womens Health Teaching Hospital, Ankara, Turkey
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Mahdavi A, Berker B, Nezhat C, Nezhat F, Nezhat C. Laparoscopic management of ovarian cysts. Obstet Gynecol Clin North Am 2004; 31:581-92, ix. [PMID: 15450319 DOI: 10.1016/j.ogc.2004.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The role of operative laparoscopy in the management of patients with adnexal masses is expanding, offering distinct advantages of lower morbidity, improved postoperative recovery, and reduced cost. Although clinical examination and the results of preoperative work-up often indicate the benign or malignant nature of the cyst, only histology can provide the absolute diagnosis. Advanced operative laparoscopy for management of ovarian cysts, when performed by experienced endoscopic surgeons, is as safe and effective as open techniques.
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Affiliation(s)
- Ali Mahdavi
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai School of Medicine, The Mount Sinai Medical Center, 5 East 98th Street, Box 1173, New York, NY 10029, USA
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Wang PH, Lee WL, Juang CM, Tsai WY, Chao HT, Yuan CC. Excision of mature teratoma using culdotomy, with and without laparoscopy: a prospective randomised trial. BJOG 2001; 108:91-4. [PMID: 11213011 DOI: 10.1111/j.1471-0528.2001.00003.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the results of removing mature teratoma with laparoscopy or without laparoscopy. DESIGN A prospective, randomised trial. SETTING Medical centre. PARTICIPANTS Seventy-nine women with mature teratomas identified using results of ultrasound examinations and biochemical markers. INTERVENTION Cystectomy with laparoscopic approach or without laparoscopic approach through a culdotomy. METHODS Patients were randomly assigned to have their cysts removed via vaginal cystectomy without laparoscopy (n = 37, Group A) or laparoscopic cystectomy via culdotomy opening (n = 42, Group B). Inclusion criteria were history of vaginal delivery, no previous abdominal surgery, no history of pelvic inflammatory disease, no medical illness, and no presenting symptoms. Eight women randomised to Group A withdrew before surgery. The laparoscopically resected tumours were each put into a cellulose bag, and tumours without laparoscopic-assistance were removed directly via the vagina. RESULTS Blood loss in Group A (88 +/- 37 ml) was significantly more than that in Group B (64 +/- 20 ml, P = 0.000). The post-operative recovery times were 20 and 17 hours, respectively (P = 0.030). The rates of successful surgery were 58.6 and 97.6%, respectively (P = 0.002). The spillage rates were 44.8% and 19.0%, respectively (P = 0.006). There were no significant differences in tumour size, patient age, and operative time between groups. CONCLUSION Cystectomy without assistance of laparoscopy could be applied to manage mature teratoma of the ovary; however, because of the difficulty of this technique, we had high percentages of tumour spillage and more blood loss during operation and a high percentage of patients who required conversion to laparotomy compared with laparoscopic cystectomy. We favoured laparoscopically assisted cystectomy to manage mature teratoma.
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Affiliation(s)
- P H Wang
- Department of Obstetrics and Gynecology, Veterans General Hospital-Taipei and Institute of Clinical Medicine, National Yang-Ming University, School of Medicine, Taiwan
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Wang PH, Lee WL, Juang CM, Tsai WY, Chao HT, Yuan CC. Excision of mature teratoma using culdotomy, with and without laparoscopy: a prospective randomised trial. ACTA ACUST UNITED AC 2001. [DOI: 10.1016/s0306-5456(00)00003-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wang PH, Lee WL, Chao HT, Yuan CC. Disseminated carcinomatosis after laparoscopic surgery for presumably benign ruptured ovarian teratoma. Eur J Obstet Gynecol Reprod Biol 2000; 89:89-91. [PMID: 10733031 DOI: 10.1016/s0301-2115(99)00171-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors reported the intraperitoneal carcinomatosis after laparoscopic surgery for presumably benign ruptured ovarian teratoma in a 28-year-old woman. A 28-year-old female patient exhibited intraperitoneal carcinomatosis after a laparoscopic surgery for ruptured mature teratoma of the ovary with occult malignant transformation. The complication was found two months after initial laparoscopic surgery. Laparoscopic surgery was smooth including oophorectomy, and removing all spilled specimens within the abdominal cavity. At the end of the laparoscopic surgery, cleaning the abdominal cavity and irritating the port site were also performed. Cytology of the abdominal cavity and all removed specimens did not show evidence of malignancy. She followed up regularly and uneventfully except for persistently abdominal fullness and erythematous change of umbilical portal site. Evidence demonstrated intestinal obstruction associated with ascites after a detailed evaluation. Although the patient received supportive treatment the symptom exacerbated. Therefore, the patient was treated with exploratory laparotomy. Pathology proved with intraperitoneal carcinomatosis caused by squamous cell carcinoma. All tumor evaluations including tumor markers, a thorough physical examination, imaging studies and evaluations of the nuclear medicine were negative except of intraperitoneal carcinoma, origin to be determined. The patient is dead 14 months' post-treatment by exploratory laparotomy. Although it was not clear that the laparoscopic approach or the disease itself worsened indeed the prognosis because the disease was already disseminated before the laparoscopy, we still emphasized the possible limitation of laparoscopic surgery if diagnosis at original surgery is impaired, of if excision is incomplete and the delay between the laparoscopic procedure and the carcinomatosis.
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Affiliation(s)
- P H Wang
- Department of Obstetrics and Gynecology, Veterans General Hospital-Taipei and National Yang-Ming University, Taiwan.
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Ayhan A, Bukulmez O, Genc C, Karamursel BS, Ayhan A. Mature cystic teratomas of the ovary: case series from one institution over 34 years. Eur J Obstet Gynecol Reprod Biol 2000; 88:153-7. [PMID: 10690674 DOI: 10.1016/s0301-2115(99)00141-4] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate bilaterality, complications and malignant changes of mature cystic teratomas of the ovary. STUDY DESIGN Retrospective study of 501 patients operated at Hacettepe University Hospital between the years of 1964 and 1998. RESULTS The median age was 35 years (range 13-76). One hundred and six cases (21.1%) were asymptomatic. The mean tumor diameter was 7.0+/-4.5 cm. The decision for cystectomy or oophorectomy was related with the patient age, gravidity and parity. The bilaterality rate when both ovaries were evaluated histopathologically was 13.2% (44/331). Total complication rate was 10.7%, torsion being the most frequent (4.9%). The rate of malignant transformation was 1.4%. CONCLUSION Ovarian mature cystic teratomas are common tumors especially during the reproductive period with low rates of covert bilaterality, complications and malignant transformation. The treatment should be directed on the basis of age, fertility desire or presence of another pelvic pathology rather than the size or bilaterality.
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Affiliation(s)
- A Ayhan
- Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Sihhiye, Ankara, Turkey.
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Wang PH, Lee WL, Yuan CC, Chao HT. A prospective, randomized comparison of port wound and culdotomy for extracting mature teratomas laparoscopically. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 1999; 6:483-6. [PMID: 10548709 DOI: 10.1016/s1074-3804(99)80015-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
STUDY OBJECTIVE To compare removing teratomas through a culdotomy opening or through an enlarged port wound. DESIGN Prospective, randomized trial (Canadian Task Force classification I). SETTING Veterans Hospital. PATIENTS Thirty-one women with mature teratomas identified by ultrasound examination and biochemical markers. INTERVENTION Laparoscopic cystectomy. MEASUREMENTS AND MAIN RESULTS Patients were randomly assigned to have the cysts removed intact in a cellulose bag through an enlarged port site (15, group A) or through a culdotomy opening (16, group B). Inclusion criteria were history of vaginal delivery, no previous abdominal surgery, no history of pelvic inflammatory disease, no medical illness, and no symptoms. Operating time in group B (90 +/- 18 min) was significantly longer than that in group A (70 +/- 22 min, p = 0. 0113). Blood loss was 79 and 49 ml, respectively (p = 0.0010). There was no significant differences in tumor size, patient age, and postoperative recovery between groups. CONCLUSION It is possible to remove intact ovarian dermoid cysts and prevent rupture and spillage of cyst contents during laparoscopic surgery by both approaches. We prefer the enlarged port because operating time is shorter and blood loss is less.
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Affiliation(s)
- P H Wang
- Department of Obstetrics and Gynecology, Veterans General Hospital-Taipei, Taiwan
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Women's Health LiteratureWatch. J Womens Health (Larchmt) 1999; 8:421-8. [PMID: 10326997 DOI: 10.1089/jwh.1999.8.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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