Laparoscopic excision of a large ovarian cyst

Abstract

Keywords Large ovarian cyst . Laparoscopic management and ovarian cyst Case reportWe present a case of laparoscopic drainage and excision of a large ovarian cyst. A 22-year-old, nulliparous woman presented to a general practitioner with occasional rightsided upper abdominal pain. An abdominal ultrasound was arranged to assess the biliary system. However, the scan identified a huge ovarian cyst filling the entire abdominal cavity from the epigastrium to the pouch of Douglas. An urgent review was arranged at the gynaecology clinic. There was generalized distension of the abdomen, but the margins of the cyst were not palpable. A repeat pelvic ultrasound scan was arranged in the gynaecological ultrasound department to examine the cyst in detail. It appeared simple in nature, with a unilocular fluid-filled cavity. The approximate size was 50×30×13 cm. No solid elements, ascites or renal system dilatation was noted on ultrasound. CA-125(15 iu/ml), CEA (2 ng/ml) and HCG (<5 iu/l) were all normal. After detailed discussion with the patient about the management options, a decision was made to perform laparoscopic drainage and excision of the cyst. The patient was aware of the possibility of oophrectomy and laparotomy if complications arose during the procedure or if it proved impossible to excise the cyst laparoscpically.The procedure was performed under general anaesthetic in the lithotomy position. A Veres needle was inserted through the umbilicus into the cyst as for routine laparoscopy and 5,800 ml of straw-coloured fluid was drained through the suction apparatus till the fluid stopped draining. The Veres needle was than removed and reinserted at the same point and CO2 in-sufflation was performed as per routine. A 10-mm trocar was then inserted with ease into the peritoneal cavity. The cyst had completely collapsed and the detailed inspection revealed origin from the right adnexa possibly ovarian in nature, but the right ovary appeared healthy and well preserved. The left ovary also appeared normal. The cyst had expanded in the mesosalpinx and broad ligament and had involved the right tube. Ureters were identified separately on both sides. Two further 5-mm ports were inserted in the suprapubic area on either side of the midline. Right partial salpingectomy and excision of the base of the cyst were performed with bipolar diathermy and laparoscpic scissors. Hemostasis was secured using bipolar diathermy. The cyst was then grasped with lockable laparoscpic forceps inserted through a suprapubic port on the left. The portal entry incision was enlarged by a further 1 cm as the port, forceps and cyst were being removed under direct vision. The cyst was removed piecemeal and both ovaries were preserved. The patient made an uneventful post-operative recovery with minimal use of oral analgesics only and was discharged the next day.The histology showed a unilocilar thin-walled cyst. The cyst wall was composed of fibrous tissue and was lined by tubal-type cuboidal epithelium. No background ovarian tissue was seen. Attached to the...

Laparoscopic management of a giant ovarian mucinous cystadenoma in a low-income African country: a case report

“…On nal pathological reports, two cysts were mucinous cystadenomas and four were serous cystadenomas [8]. Rabbani et al reported in a case report of a huge ovarian cyst the use of a Veres needle to aspirate and drain the contents of the cyst and perform a cystectomy [9]. A. Alobaid et al described a case series of 5 patients with huge ovarian cysts successfully managed by laparoscopy.…”

Laparoscopic management of giant ovarian cysts in adolescents.

“…Leakage of the cyst contents may result in chemical peritonitis or dissemination of cells in the case of malignant tumour [1, 3]. Although the significance of this leakage is controversial, we suggest avoiding it whenever possible [3, 5, 7]. This can be achieved in our opinion by percutaneous drainage of the cyst and insertion of the first trocar according to the Hasson technique [8].…”