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Eisenberg N, Volodarsky-Perel A, Brochu I, Tremblay C, Gorak E, Hudon E, Fortin S, Kogan L, Rivard C. Short- and Long-Term Complications of Intraoperative Benign Ovarian Cyst Spillage: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 28:957-970. [PMID: 33279627 DOI: 10.1016/j.jmig.2020.11.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/23/2020] [Accepted: 11/28/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To review short- and long-term complications associated with intraoperative rupture of benign ovarian cysts. DATA SOURCES The Cochrane Central Register of Controlled Trials, BIOSIS, Medline (Ovid), Web of Science, ClinicalTrials.gov, and Google Scholar were searched using the following terms and their combinations: "spillage," "rupture," "leakage," "ovarian cyst," "teratoma," "dermoid," "operative," "surgery," "outcome." METHODS OF STUDY SELECTION Randomized controlled and observational studies evaluating the operative outcomes of surgical treatment of ovarian cysts with intraoperative spillage compared with those of surgical treatment of ovarian cysts without spillage were included. A systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. TABULATION, INTEGRATION, AND RESULTS A total of 28 studies were included in the qualitative analysis and 12 in the quantitative analysis. Ovarian cyst diameter was not found to be associated with the risk for spillage (relative risk [RR] 0.75; 95% confidence interval [CI], -0.33 to 1.82). Intraoperative benign ovarian cyst rupture was not associated with adverse short- and long-term outcomes such as reoperation (RR 1.16; 95% CI, 0.39-3.48), infertility (RR 0.73; 95% CI, 0.15-3.63), transient fever (RR 3.22; 95% CI, 0.83-12.51), and readmission (RR 1.00; 95% CI, 0.33-2.98). However, intraoperative spillage was found to be associated with increased risk for benign recurrence (RR 3.1; 95% CI, 1.05-9.14). A subgroup analysis of the studies that included only dermoid cysts showed an association between intraoperative cyst rupture and postoperative chemical peritonitis (RR 9.36; 95% CI, 1.20-73.28). CONCLUSION Intraoperative ovarian cyst spillage of a benign cyst is associated with limited adverse clinical outcomes. Although the surgical approach (minimally invasive vs open) should not be affected by the concern regarding an intraoperative cyst rupture, maximal efforts should be made to prevent intra-abdominal spillage.
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Affiliation(s)
- Neta Eisenberg
- Department of Obstetrics and Gynecology, Université de Montréal (Drs. Eisenberg, Brochu, Tremblay, Gorak, Hudon, Fortin, and Rivard); Department of Obstetrics and Gynecology, Shamir (Assaf Harofeh) Medical Center (Dr. Eisenberg)
| | - Alexander Volodarsky-Perel
- Lady Davis Institute of Medical Research, McGill University (Dr. Volodarsky-Perel), Montreal, Quebec, Canada; Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer (Dr. Volodarsky-Perel), affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Ian Brochu
- Department of Obstetrics and Gynecology, Université de Montréal (Drs. Eisenberg, Brochu, Tremblay, Gorak, Hudon, Fortin, and Rivard)
| | - Catherine Tremblay
- Department of Obstetrics and Gynecology, Université de Montréal (Drs. Eisenberg, Brochu, Tremblay, Gorak, Hudon, Fortin, and Rivard)
| | - Emilie Gorak
- Department of Obstetrics and Gynecology, Université de Montréal (Drs. Eisenberg, Brochu, Tremblay, Gorak, Hudon, Fortin, and Rivard)
| | - Emilie Hudon
- Department of Obstetrics and Gynecology, Université de Montréal (Drs. Eisenberg, Brochu, Tremblay, Gorak, Hudon, Fortin, and Rivard)
| | - Suzanne Fortin
- Department of Obstetrics and Gynecology, Université de Montréal (Drs. Eisenberg, Brochu, Tremblay, Gorak, Hudon, Fortin, and Rivard)
| | - Liron Kogan
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hadassah Medical School, Hebrew University, Jerusalem (Dr. Kogan), Israel.
| | - Chantal Rivard
- Department of Obstetrics and Gynecology, Université de Montréal (Drs. Eisenberg, Brochu, Tremblay, Gorak, Hudon, Fortin, and Rivard)
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Simon P, Noterman D, Anaf V. Diagnostic and Therapeutic Approach of Dermoid Cysts: Retrospective Study of 30 Cases. Acta Chir Belg 2020. [DOI: 10.1080/00015458.1998.12098404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ph. Simon
- Department of Gynaecology-Obstetrics, Hôpital Erasme, Brussels, Belgium
| | - D. Noterman
- Department of Gynaecology-Obstetrics, Hôpital Erasme, Brussels, Belgium
| | - V. Anaf
- Department of Gynaecology-Obstetrics, Hôpital Erasme, Brussels, Belgium
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3
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Eisman LE, Stull C, Barmat LI. Prolonged Chemical Peritonitis Following Intraperitoneal Rupture of a Dermoid Cyst. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2016.0040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Laura E. Eisman
- Department of Obstetrics and Gynecology, Abington Hospital, Abington, PA
| | - Carolyn Stull
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA
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Ovarian Mature Cystic Teratoma: Challenges of Surgical Management. Obstet Gynecol Int 2016; 2016:2390178. [PMID: 27110246 PMCID: PMC4823513 DOI: 10.1155/2016/2390178] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 02/29/2016] [Indexed: 12/26/2022] Open
Abstract
Although ovarian mature cystic teratomas are the commonest adnexal masses occurring in premenopausal women, there are many challenges faced by gynecologists on deciding upon the best surgical management. There is uncertainty, lack of consensus, and variation in surgical practices. This paper critically analyzes various surgical approaches and techniques used to treat these cysts in an attempt to outline a unified guidance. MEDLINE and EMBASE databases were searched in January 2015 with no date limit using the key words “ovarian teratoma” and “ovarian dermoid.” The search was limited to articles in English language, humans, and female. The two authors conducted the search independently. The laparoscopic approach is generally considered to be the gold standard for the management. Oophorectomy should be the standard operation except in younger women with a single small cyst. The risk of chemical peritonitis after contents spillage is extremely rare and can certainly be overcome with thorough peritoneal lavage using warmed fluid. There is a place for surveillance in some selected cases.
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Yi SW, Ju DH, Lee SS, Sohn WS. Transumbilical retrieval of surgical specimens through a multichannel port. JSLS 2014; 18:JSLS-D-14-00178. [PMID: 25408603 PMCID: PMC4232406 DOI: 10.4293/jsls.2014.00178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Laparoscopic surgery is often used to excise adnexal masses; however, the retrieval of specimens such as large cystic masses through conventional 5- or 10-mm ports is difficult and time-consuming. We compared outcomes between conventional laparoscopic surgery for adnexal masses and transumbilical specimen retrieval through a multichannel port during single- or 2-port laparoscopy. Methods: A total of 341 patients who underwent laparoscopic surgery for adnexal masses from November 2006 to December 2010 were included. The patients were divided into 2 groups: group I consisted of 249 patients who underwent conventional laparoscopy, and group II consisted of 92 patients who underwent single- or 2-port laparoscopy using a multichannel port. The clinical characteristics and operative outcomes of the 2 groups were compared. Results: The mean operation time was 51.8 ± 21.5 minutes in group I and 57.2 ± 23.9 minutes in group II. The mean specimen retrieval time was longer in group I (2.9 ± 4.0 minutes) than in group II (2.2 ± 1.8 minutes). Endoscopic bag rupture during specimen retrieval occurred in 11 patients in group I and in no patients in group II. Conclusions: The transumbilical retrieval of surgical specimens through a multichannel port with a wound retractor was safe and did not result in leakage of the cystic contents. This technique reduced the specimen retrieval time, especially for large masses. However, the mean operation time was not shortened with this procedure, because of the learning period and the time required to prepare the umbilical multichannel port.
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Affiliation(s)
- Sang Wook Yi
- Department of Obstetrics and Gynecology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon, Korea
| | - Da Hye Ju
- Department of Obstetrics and Gynecology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon, Korea
| | - Sang Soo Lee
- Department of Obstetrics and Gynecology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon, Korea
| | - Woo Seok Sohn
- Department of Obstetrics and Gynecology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon, Korea
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Liu DSH, Mignanelli E. Granulomatous peritonitis after ruptured teratoma mimicking peritoneal carcinomatosis. ANZ J Surg 2012. [DOI: 10.1111/j.1445-2197.2012.06307.x] [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]
Affiliation(s)
- David Shi Hao Liu
- Department of Surgery; Austin Hospital; Heidelberg; Victoria; Australia
| | - Emilio Mignanelli
- Department of General Surgery; Royal Hobart Hospital; Hobart; Tasmania; Australia
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A minimally invasive approach to laparoscopic surgery for large adnexal cysts with a multichannel port using a wound retractor. Surg Laparosc Endosc Percutan Tech 2012; 22:e176-81. [PMID: 22874694 DOI: 10.1097/sle.0b013e318253dcfc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study explored and evaluated the feasibility and safety of laparoscopy with a multichannel port using a wound retractor for large adnexal masses. Seven patients scheduled to undergo single-port or 2-port laparoscopy for large adnexal cysts were enrolled. The cystic mass surface was exposed by inserting the wound retractor through the umbilical port, and cystic fluid was aspirated using a suction-irrigation system after puncture with an Ochsner trocar. Then, laparoscopic adnexal surgery was performed in the usual manner. The mean maximal diameter of cysts, mean operation time, and mean postoperative hospital stay were 17.8 ± 5.4 cm, 81.3 ± 28.2 minutes, and 4.4 ± 2.0 days, respectively. Use of multichannel ports for large adnexal cystic masses seems safe and does not require additional cost. The procedure is also cosmetically effective and highly appreciated by patients, because it results in minimal abdominal scarring.
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Yi SW. Minimally invasive management of huge ovarian cysts by laparoscopic extracorporeal approach. MINIM INVASIV THER 2012; 21:429-34. [PMID: 22211916 DOI: 10.3109/13645706.2011.644855] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Laparoscopy has been widely performed in adnexal surgery for benign masses. For large adnexal masses, laparoscopy has not been commonly used and laparotomy remains the gold standard due to several technical difficulties in the former, including a limited surgical field, risk of unintended cyst rupture during the insertion of the Veress needle or trocar, and the possibility of malignancy. Recent advances in laparoscopic techniques have offered acceptable options for performing laparoscopy in patients with very large adnexal cysts. We performed ovarian cystectomy of huge ovarian cysts via a laparoscopic extracorporeal approach through an umbilical single-site incision, successfully minimizing the possibility of cyst contents leaking into the peritoneal cavity. Use of a single-site incision at the umbilicus for huge adnexal cystic masses appears safe and spares the additional costs of using conventional surgical instruments. It is also cosmetically effective and highly appreciated by patients because it results in minimal abdominal scarring.
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Affiliation(s)
- Sang Wook Yi
- Division of Minimally Invasive Surgery & Gynecologic Laparoendoscopy, Department of Obstetrics and Gynecology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon, Korea.
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9
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Yi SW. Two-Port Laparoscopic Adnexal Surgery with a Multichannel Port Using a Wound Retractor: Is It Safe and Minimally Scarring? J Laparoendosc Adv Surg Tech A 2009; 19:781-6. [DOI: 10.1089/lap.2009.0052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sang-Wook Yi
- Department of Obstetrics and Gynecology, Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangneung, Korea
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10
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Medeiros LRF, Rosa DD, Bozzetti MC, Fachel JMG, Furness S, Garry R, Rosa MI, Stein AT. Laparoscopy versus laparotomy for benign ovarian tumour. Cochrane Database Syst Rev 2009:CD004751. [PMID: 19370607 DOI: 10.1002/14651858.cd004751.pub3] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Over the last 10 years laparoscopy and minilaparotomy have become increasingly common approaches for the surgical removal of benign ovarian tumours. However, in the event that a tumour is found to be malignant, laparotomy is the appropriate procedure. Careful preoperative assessment including transvaginal ultrasound with morphological scoring, colour doppler assessment of vascular quality, and serum cancer antigen 125 (CA 125) level is desirable. OBJECTIVES To determine the benefits, harms, and cost of laparoscopy or minilaparotomy compared with laparotomy in women with benign ovarian tumours. SEARCH STRATEGY We searched electronic databases, trial registers, and reference lists of published trial reports. Reference lists from trials and review articles were searched. SELECTION CRITERIA All randomised controlled trials comparing either laparoscopy or minilaparotomy with laparotomy for benign ovarian tumours. DATA COLLECTION AND ANALYSIS Eight review authors independently assessed the eligibility and quality of each study and extracted the data. MAIN RESULTS The results of nine randomised controlled trials (N = 482 women) showed that laparoscopic surgery was associated with fewer adverse events of surgery (surgical injury or postoperative complications including fever or infection) (OR 0.3, 95% CI 0.2 to 0.5), less postoperative pain (VAS score WMD -2.4, 95% CI -2.7 to -2.0), greater likelihood of being pain free after two days (OR 7.42, 95% CI 4.86 to 11.33), and fewer days in hospital (WMD -2.88, 95% CI -3.1 to -2.7) than with laparotomy.In one study that reported costs, laparoscopy was associated with a significant reduction in costs compared to laparotomy (WMD - USD 1045, 95% CI -1348 to -742) in 1993. Very high levels of heterogeneity made it inappropriate to pool data on duration of surgery.Three RCTs compared laparoscopy versus minilaparotomy and found that laparoscopy was associated with reduced odds of any adverse event (surgical injury or postoperative complications) (OR 0.10, 95% CI 0 to 0.8) and lower VAS scores for pain (WMD -1.0, 95% CI -1.6 to -0.45). Duration of hospital stay ranged between 1 and 2.2 days, with substantial heterogeneity. AUTHORS' CONCLUSIONS In women undergoing surgery for benign ovarian tumours, laparoscopy was associated with a reduction in fever, urinary tract infection, postoperative complications, postoperative pain, number of days in hospital, and total cost. These findings should be interpreted with caution since only a small number of studies were identified. These included a total of only 769 women and not all of the important outcomes were reported in each study.
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Affiliation(s)
- Lídia R F Medeiros
- Social Medicine/Epidemiology, Federal University of Rio Grande do Sul, Jose de Alencar 1244, 1009 Menino Deus, Porto Alegre, Rio Grande do Sul, Brazil, 90880-480.
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Chen Y, Xu H, Li Y, Li J, Wang D, Yuan J, Liang Z. Laparoscopic resection of presacral teratomas. J Minim Invasive Gynecol 2009; 15:649-51. [PMID: 18722980 DOI: 10.1016/j.jmig.2008.06.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 06/18/2008] [Accepted: 06/21/2008] [Indexed: 12/20/2022]
Abstract
Presacral and retrorectal space tumors are relatively rare lesions, the location of which can result in the onset of symptoms that are not well-defined. Retrorectal teratomas are resected to alleviate these symptoms and to rule out malignancy. Complete resection by one of the open abdominal or sacral approaches was traditionally advocated as the best treatment for either a benign or malignant presacral and retrorectal tumor. A 15-year-old girl had chronic, progressively worsening dull pelvic pain and was given the diagnosis of a retrorectal tumor during her first gynecologic examination. Computed tomography of the pelvis showed an encapsulated presacral and retrorectal tumor measuring 10x8.5x8 cm. The retrorectal teratoma was removed by laparoscopy. No complication was observed interoperation. In addition, no sensory or motoric dysfunction of the bladder or rectum was observed postoperatively. Laparoscopy can be used to surgically remove presacral teratomas.
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Affiliation(s)
- Yong Chen
- Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University, Chongqing, PR China
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12
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Medeiros LR, Stein AT, Fachel J, Garry R, Furness S. Laparoscopy versus laparotomy for benign ovarian tumor: a systematic review and meta-analysis. Int J Gynecol Cancer 2007; 18:387-99. [PMID: 17692084 DOI: 10.1111/j.1525-1438.2007.01045.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To determine the efficacy, safety, and cost of laparoscopic surgery compared with laparotomy in women with ovarian tumors assumed to be benign. This study is a systematic review. We searched (MEDLINE, EMBASE, LILACS, and COCHRANE LIBRARY) trials registers and reference lists of published trial reports. Six randomized controlled trials were identified involving 324 patients. Duration of surgery, adverse effects of surgery, pain, length of hospital stay, and economic outcomes were compared. The mean duration of surgery was longer in the laparoscopy group overall (weighted mean difference 11.39, 95% CI 0.57-22.22). The pooled estimate for febrile morbidity decreased for laparoscopy (Peto OR 0.34, 95% CI 0.13-0.88). The odds of any adverse effect were decreased after laparoscopic procedures (Peto OR 0.26, 95% CI 0.12-0.55). The odds of being pain free were significantly greater for the laparoscopy group (Peto OR 7.35, 95% CI 4.3-12.56). Mean length of hospital stay was shorter in the laparoscopy group with reduction of 2.79 days (95% CI -2.95 to -2.62). In economic outcomes, there was a significant reduction of US$1045 (95% CI -1361 to -726.97) in the laparoscopy group. Laparoscopy is associated with a reduction in the following: febrile morbidity, urinary tract infection, postoperative complications, postoperative pain, days in hospital, and total cost. These findings should be interpreted with caution as only a small number of studies were identified including a total of only 324 women.
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Affiliation(s)
- L R Medeiros
- Postgraduate Program in Epidemiology: Medical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
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Medeiros LR, Fachel JMG, Garry R, Stein AT, Furness S. Laparoscopy versus laparotomy for benign ovarian tumours. Cochrane Database Syst Rev 2005:CD004751. [PMID: 16034946 DOI: 10.1002/14651858.cd004751.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Over the last ten years laparoscopy has become an increasingly common approach for the surgical removal of benign ovarian tumours. There remains uncertainty as to the value of this intervention. This review has been undertaken to assess the available evidence for the benefits and harms of laparoscopic surgery for benign ovarian tumours compared to laparotomy. OBJECTIVES To determine the efficacy, safety and cost of laparoscopic surgery compared with laparotomy in women with ovarian tumours assumed to be benign. SEARCH STRATEGY We searched electronic databases, trials registers and reference lists of published trial reports. Review articles were also searched. SELECTION CRITERIA All randomised controlled trials comparing laparoscopy versus laparotomy for benign ovarian tumours. DATA COLLECTION AND ANALYSIS Three reviewers independently assessed each study's eligibility and quality and extracted data. MAIN RESULTS Six randomised controlled trials were identified involving 324 patients. Three subgroups of ovarian tumours were considered: any histological type of benign ovarian tumour, dermoid cysts and endometriomata. Surgical outcomes: The mean duration of surgery was longer in the laparoscopy group compared to the laparotomy group overall (WMD 11.39; 95% CI 0.57 to 22.22). However, heterogeneity was present with substantial inconsistency (I(2)=87%) . The heterogeneity found in these analyses was likely to reflect differences in the patient populations. Adverse effects of surgery: The pooled estimate for febrile morbidity decreased for laparoscopy compared to laparotomy (Peto OR 0.34; 95% CI 0.13 to 0.88). The odds of any adverse effect of surgery (total number of complications - surgical injury and/or post operative complications) were decreased after laparoscopic procedures (Peto OR 0.26; 95% CI 0.12 to 0.55). Short-term recovery: VAS pain scores favoured laparoscopy (WMD -2.36; 95% CI -2.07 to -2.03) andt he odds of being pain free were significantly greater for the laparoscopy group compared to laparotomy (Peto OR 7.35; 95% CI 4.3 to 12.56). Mean length of hospital stay was shorter in the laparoscopy group with reduction 2.79 days (95% CI -2.95 to -2.62) compared to laparotomy. Economic outcomes: There was a significant reduction of US$1045 (95% CI -1361 to -726.97) in the laparoscopy group compared to the laparotomy group in one trial of women with any type of benign ovarian tumour. AUTHORS' CONCLUSIONS In women undergoing surgery for benign ovarian tumours, laparoscopy is associated with a reduction in the following; febrile morbidity, urinary tract infection, post operative complications, post operative pain, days in hospital and total cost. These findings should be interpreted with caution as only a small number of studies were identified including a total of only 324 women and not all of the important outcomes were reported in each study.
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Affiliation(s)
- L R Medeiros
- Social Medicine, Faculty of Medicine, Federal University of Rio Grande do Sul, Ramiro Barcelos 2300, Porto Alegre, Rio Grande do Sul, Brazil, 90035-000.
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Badawy AM, Allakkany NS, El-Gohary AS, Youssef HM, Nazar M. Laparoscopy or laparotomy in the management of benign adnexal cysts in premenopausal women. ACTA ACUST UNITED AC 2003. [DOI: 10.1046/j.1365-2508.2002.00528.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mattei A, Giannone E, Carlo Di Renzo G, Gerli S. Laparoscopic removal of benign uterine and adnexal masses during pregnancy. ACTA ACUST UNITED AC 2001. [DOI: 10.1046/j.1365-2508.1999.00233.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Campo S, Marone M, Gambadauro P, Garcea N. Laparoscopic conservative excision of a rare asymptomatic 11-cm ovarian dermoid cyst containing a mandible with seven teeth. ACTA ACUST UNITED AC 2001. [DOI: 10.1046/j.1365-2508.2000.00284.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mecke H, Savvas V. Laparoscopic surgery of dermoid cysts--intraoperative spillage and complications. Eur J Obstet Gynecol Reprod Biol 2001; 96:80-4. [PMID: 11311766 DOI: 10.1016/s0301-2115(00)00390-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the risks of complications including intraoperative spillage following laparoscopic dermoid cyst enucleation. STUDY DESIGN A retrospective case series comparison of 390 patients who had surgery at our hospital from 1992 to 1998 for teratomas of the ovary. RESULTS 43 patients were treated with laparotomy. Two malignant teratomas were observed in this group. In seven patients, the dermoid cysts were removed as part of a vaginal hysterectomy. Three hundred and forty patients had surgery via laparoscopy. Enucleation of the dermoid cyst in toto using a salvage bag for removal was only possible in few cases without contamination of the abdominal cavity by spillage of cyst contents. There were no serious complications in any patients including those with laparoscopic cystectomies and intraperitoneal spill. CONCLUSION The laparoscopic treatment of benign teratomas is a safe procedure. Primary laparotomy as well as adenectomy is also to be taken into consideration with young patients, if suspicion of malignancy, rapid growth, doubtful infiltration or large size of tumor is present.
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Affiliation(s)
- H Mecke
- Department of Obstetrics and Gynecology, Auguste-Viktoria-Hospital, Berlin, Germany
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Templeman CL, Fallat ME, Lam AM, Perlman SE, Hertweck SP, O'Connor DM. Managing mature cystic teratomas of the ovary. Obstet Gynecol Surv 2000; 55:738-45. [PMID: 11128910 DOI: 10.1097/00006254-200012000-00004] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mature cystic teratomas (MCT), commonly called dermoid cysts, are the most common benign germ cell tumors of the ovary in women of reproductive age. Future fertility is of major concern among these women; therefore, the surgical management must focus on preserving ovarian tissue and minimizing adhesion formation. Patients requiring surgery should be appropriately counseled about the risks and benefits of laparoscopy and laparotomy, the risks of intraoperative MCT spillage and adhesion formation. In addition, the risks of recurrence and malignant transformation should be discussed. The parents of children with MCTs have the same concerns as older women and a similar discussion should take place. The goal of this article is to review these issues and provide the physician with the information to counsel their patients preoperatively.
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Affiliation(s)
- C L Templeman
- Department of Obstetrics and Gynecology, University of Louisville, Kentucky, USA
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Campo S, Garcea N. Laparoscopic conservative excision of ovarian dermoid cysts with and without an endobag. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 1998; 5:165-70. [PMID: 9564065 DOI: 10.1016/s1074-3804(98)80084-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVE To compare outcomes of conservative laparoscopic treatment of dermoid cysts removed from the abdominal cavity without (group A) and with an endobag (group B). DESIGN Prospective, randomized, 4-year (June 1992-June 1996) study (Canadian Task Force classification I). SETTING Department of Obstetrics and Gynecology of the Catholic University of the Sacred Heart in Rome. PATIENTS Fifty-five premenopausal women with dermoid cysts. Intervention. Patients were randomly assigned to removal of dermoid cysts from the abdominal cavity with or without an endobag through a 10- to 12-mm cannula sleeve. MEASUREMENTS AND MAIN RESULTS We assessed surgical time, spillage, complications, length of hospitalization, recurrences, and pregnancies. In the 55 women, 58 dermoid cysts (mean diameter 5.6 +/- 2.03 cm) were enucleated and removed at operative laparoscopy through a 10- to 12-mm cannula sleeve without intraoperative or postoperative complications. Mean operating time was 73 minutes. When cysts were removed with an endobag, operating time was significantly reduced over removal without the endobag (63 vs 81 min, p <0.05). Obvious spillage of endocystic contents occurred in 13 (43.3%) patients in group A but in only 1 patient in group B because the bag ruptured (p <0.05). No signs or symptoms of peritonitis were observed in women with evident cystic spillage or in those in group A in whom spillage was possible. Average postoperative hospital stay was 1.7 days and did not differ between groups. Among 20 infertile women, 9 (45%) experienced spontaneous pregnancy within a year, with no differences between groups. Echographic follow-up did not reveal cyst recurrence. CONCLUSIONS Laparoscopic conservative cystectomy of dermoid cysts in premenopausal women is safe and effective and appears to be a valuable alternative to laparotomy. Removing cysts in an endobag significantly reduced both operating time and spillage. However, controlled intraperitoneal spillage of cyst contents does not increase postoperative morbidity as long as the peritoneal cavity is thoroughly washed.
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Affiliation(s)
- S Campo
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
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Rosen DM, Lam AM, Carlton MA, Cario GM. The safety of laparoscopic treatment for ovarian dermoid tumours. Aust N Z J Obstet Gynaecol 1998; 38:77-9. [PMID: 9521397 DOI: 10.1111/j.1479-828x.1998.tb02964.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- D M Rosen
- Sydney Women's Endosurgery Centre and St George Hospital, Department of Obstetrics and Gynaecology, University of New South Wales, Kogarah
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Parker WH, Childers JM, Canis M, Phillips DR, Topel H. Laparoscopic management of benign cystic teratomas during pregnancy. Am J Obstet Gynecol 1996; 174:1499-501. [PMID: 9065118 DOI: 10.1016/s0002-9378(96)70595-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Our purpose was to evaluate the surgical management and outcome of laparoscopic removal of benign cystic teratomas during pregnancy. STUDY DESIGN The records of women with benign cystic teratomas who were managed with operative laparoscopy during pregnancy were reviewed. RESULTS Twelve women had laparoscopic removal of a benign cystic teratoma during pregnancy. Gestational ages at surgery ranged from 9 to 17 weeks, with a mean of 14 weeks. Cyst size ranged from 5 to 13 cm, with a mean of 8.5 cm. Intraoperative rupture of the cyst occurred in 10 of 12 (93%) women. No patient had evidence of chemical peritonitis. The mean operating time was 87 minutes and the mean postoperative hospital stay was 44 hours. No intraoperative or postoperative maternal or fetal complications occurred. CONCLUSIONS Laparoscopic removal of a benign cystic teratoma of the ovary may be safely accomplished during pregnancy. In spite of a significant risk of cyst rupture, careful operative technique followed by copious irrigation of the pelvis may avoid chemical peritonitis and potential adverse sequelae.
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Affiliation(s)
- W H Parker
- Department of Obstetrics and Gynecology, University of California, Los Angeles, School of Medicine, USA
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Abstract
The Author intends to compare the data available in literature on the topic of 'laparoscopic surgery of ovarian cysts' to his case material. From 1985 to 1994, the author carried out 920 laparoscopic operations for the removal of ovarian cysts. Of these, 13 were converted to laparotomies, mostly because of peri-adnexal adhesions. There were 22 recurrences (endometriosic and mucinous multilocular cysts), and five severe complications (two purulent inflammations, one intra-operative haemorrhage and one post-operative one, one post-operative acute abdomen sine causa). In one case, an unrecognised endometrioid carcinoma was inadequately treated with laparoscopy. The author considers laparoscopy as the elective choice for surgical treatment of ovarian cysts. Suspect malignancy is not a contra-indication to laparoscopic surgery, since the removal of the operative specimen and its subsequent histological examination can be effected-in the large majority of cases-with the same results both laparoscopically and laparotomically. There is a problem with undiagnosed carcinomas in fertile females, but it is equally present in laparotomy.
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Affiliation(s)
- L Minelli
- C. Poma Hospital, Department of Obstetrics and Gynaecology, Mantova, Italy
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Tsin DA, Espinoza de los Monteros JA, Colombero L. Laparoscopic techniques for extracting ovarian teratomas. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 1996; 3:283-6. [PMID: 9050641 DOI: 10.1016/s1074-3804(96)80014-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We performed two techniques for laparoscopic extraction of benign ovarian teratomas. For cysts up to 5 cm, we used the pouch technique, with partial extraction followed by enlargement of the hypogastric port. A skin incision was enlarged to allow the use of a scalpel in the pouch. This enabled us to perform several stab incisions in the cyst to spill its contents while still holding it in the pouch. This was followed by suction irrigation and forceps removal of the contents until the collapsed cyst could be removed in the pouch. For a cyst over 5 cm, we performed endoscopic aspiration irrigation with hot water inside the cyst, followed by partial extraction of the cyst; an opening was made in the exposed cyst wall and the contents extracted as described. When the cyst wall collapsed, we proceeded with the final extraction. When spillage occurred, it was managed with extensive warm lavage of the peritoneum, skimming the floating debris with suction tubing until clear, and underwater inspection and removal of teeth and other solid material. With these techniques, we experienced no complications.
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Affiliation(s)
- D A Tsin
- Department of Gynecology, Western Queens Community Hospital, New York, New York, USA
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Hessami SH, Kohanim B, Grazi RV. Laparoscopic excision of benign dermoid cysts with controlled intraoperative spillage. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 1995; 2:479-81. [PMID: 9050607 DOI: 10.1016/s1074-3804(05)80075-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Due to the risk of aseptic peritonitis associated with intraoperative rupture of dermoid cysts, many surgeons are reluctant to remove the lesions laparoscopically. In our series, 12 dermoid cysts were removed laparoscopically. Intraoperative spillage occurred in all cases and was managed with copious lavage. None of the patients experienced postoperative morbidity associated with peritonitis, indicating that intraoperative spillage of dermoid cysts is not associated with morbidity as long as vigorous lavage is performed.
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Affiliation(s)
- S H Hessami
- Robert C. Byrd Health Sciences Center of West Virginia University, Department of Obstetrics and Gynecology, 4601 Health Sciences North, P.O. Box 9186 Morgantown, WV 26506-9186, USA
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