Complete resection of adnexal masses with endobag extraction: the risk of involuntary tumour rupture

Abstract

Objective In a prospective study we analysed the frequency of intraoperative capsule rupture among 161 ovarian tumours operated on endoscopically, using total removal of the adnexa with protected retrieval. Subjects and methods Between June 1993 and September 1997 we carried out endoscopic surgery on 161 consecutive patients, presenting with ovarian tumours up to 10 cm in diameter, and assumed to have an increased risk for malignancy on the basis of menopausal status, sonography findings or endoscopic evaluation. The risk of tumour rupture was related to the different phases of the operation (resection and extraction) and to the presence and location of intra‐abdominal adhesions. Results Malignancies were found in 6.83% of the patients. Capsule rupture occurred in 13 cases (8%). There was no instance of malignant cell spillage because of intraoperative capsule rupture. The statistical probability of malignant cell dissemination was 0.55% in our series. During resection, rupture of suspicious but not malignant tumours occurred in six cases (3.7%). The probability of spilling cyst contents was closely associated with the presence and the location of intra‐abdominal adhesions, the highest spillage rate (16.6%) being found in tumours with adhesions to intestine. During extraction, contamination on account of bag rupture occurred in seven cases (4.3%). Conclusion Using adequate endoscopic resection and removal techniques, suspicious ovarian tumours under 10 cm in diameter can be operated on endoscopically with a low risk of tumour rupture.

Intraoperative Rupture of the Ovarian Capsule in Early-Stage Ovarian Cancer

“…Thirty-eight of these studies were excluded due to a lack of comparison of progression-free survival or overall survival between the intraoperative capsule rupture and no capsule rupture groups (19 studies), incorrect study type according to our inclusion criteria (13 studies), incorrect population (three studies), incorrect intervention (two studies), and duplicate populations (one study). 6,16–52 The data quality of the remaining articles was assessed using the Newcastle-Ottawa Scale (Appendix 2, available online at http://links.lww.com/AOG/C345). Seventeen studies met all the criteria for inclusion in our meta-analysis.…”

“…Seventeen studies met all the criteria for inclusion in our meta-analysis. 5,7,14,15,53–65 The PRISMA flow diagram shows the entire review process from the original search to the final selection (Fig. 1).…”

Manejo Laparoscopico Conservador De Quiste Dermoide Conteniendo Una Mandibula Y 13 Dientes

“…El principal problema en el tratamiento conservador de estos tumores, es la rotura de la cápsula durante la disección, con el consiguiente derrame de su contenido ocasionando peritonitis química y un cuadro granulomatoso peritoneal adherencial, que si no se toman precauciones como es la irrigación y aspiración con abundante suero tibio fisiológico, podrían dejar secuelas posteriores. La rotura del quiste puede también ocurrir cuando la excisión se hace por laparotomía, pero esta al ser abierta, no tiene el inconveniente de la rotura durante la extracción de la pieza operatoria, que sí puede ocurrir en el caso de la cirugía laparoscópica, que es la rotura de la bolsa durante la extracción por la punción suprapúbica (3,13,16). Para evitar el derrame del contenido, se han ideado diferentes técnicas para la extracción del quiste enucledo desde la cavidad peritoneal, como es la ampliación de la punción suprapúbica, punción evacuadora y extracción, bolsas de politileno (endobag), uso del diafragma pélvico y la extracción a través del fondo de saco anterior y posterior con asistencia laparoscópica (3,6,8,14,16).…”