A Modified Technique to Reduce Spillage and Operative Time: Laparoscopic Ovarian Dermoid Cyst Enucleation ‘in a Bag’

Abstract

Background: To describe the outcomes of a modified technique for conservative laparoscopic enucleation of ovarian dermoid cyst, placing the ovary in an endobag during enucleation to prevent intraperitoneal spillage. Methods: Laparoscopic dermoid cyst enucleation was performed in 35 cases of premenopausal patients placing the ovary in an endobag at the beginning of the procedure and removing the cyst from the abdominal cavity by the same endobag. Results: Dermoid cysts with a mean diameter of 6.3 ± 2.7 cm were enucleated and removed laparoscopically ‘in a bag’ without intra- or postoperative complications. Cyst rupture occurred in 10 cases (28.5%), but evident peritoneal contamination occurred in only 2 (5.7%; 95% confidence interval: 0.7–19.2%), because in 8 patients spillage was contained by the surrounding bag. The mean operative time was 64.6 ± 27 min. No signs or symptoms of peritonitis were observed. The mean postoperative hospitalization was 1.6 ± 1.4 days. Among the 12 infertile patients, 7 spontaneous pregnancies (58%) occurred. Conclusions: Laparoscopic conservative excision of dermoid cysts placing the ovary in an endobag at the beginning of surgery and removing the cyst by the same bag is a safe and effective approach to reduce intraperitoneal spillage and operative time.

A Modified Technique to Reduce Spillage and the Operative Time in Laparoscopic Dermoid Cyst Excision

“…The mean operative time was 64 minutes (range, 30-110 minutes) in the study of Campo at al. 10 In our study, the mean operative time was 40 minutes (range, 25-60 minutes). We believe that controlled drilling reduces the operative time during laparoscopic dermoid cyst excision in a bag.…”

“…Modified techniques, such as performing the surgery in a bag, have been developed to prevent spillage of the cyst contents into the abdomen. 10 However, the risk of spillage remains with these techniques.…”

“…In the event of spillage intraoperatively, copious washing with isotonic solutions must be performed to reduce the risk of these reactions. 15 Campo et al 10 performed laparoscopic dermoid cyst enucleation in a bag and retrieved the cyst with the same bag. Although they tried to extract the cyst intact, unintended cyst wall rupture occurred in 10 of 35 cases (28%).…”

Cutaneous Fistulization of an Ovarian Mature Cystic Teratoma: An Unusual Occurrence

“…Spontaneous rupture of MCTs can be diagnosed radiologically [6]. Rupture of the capsule yields spillage and inoculation of the sebaceous material into the abdominal cavity [7]. Hemorrhage, chemical peritonitis and shock may further complicate the situation.…”

Transumbilical Retrieval of Surgical Specimens Through a Multichannel Port

“…Some surgeons perform cyst enucleation in a bag to reduce spillage and operation time. 15 We performed adnexectomy and cystectomy with minimal leakage of the cystic contents by using endoscopic bags or immediately closing the puncture site after cyst aspiration. After removing the mass, we also performed pelvic cavity lavage with a large volume of normal saline.…”