Laparoscopic management of selected solid adnexal tumors

Abstract

Fourteen cases of laparoscopically treated solid/ predominantly solid nonepithelial adnexal tumors are presented. Unilateral salpingo-oophorectomy was performed in seven cases [three fibromas, one thecoma, one strumal carcinoid, one Sertoli-Leydig cell tumor (G2), and one dysgerminoma], including a 21-year-old patient with fibroma with adnexal torsion. A 26-year-old patient with fibroma was treated by tumorectomy. Laparoscopicassisted vaginal hysterectomy and bilateral salpingooophorectomy were done in five cases [three thecomas, one adult-type granulosa cell tumor, one Sertoli-Leydig cell tumor (G2)], including a 52-year-old patient with thecoma complicated by torsion. In a case of adenomatoid tumor of the fallopian tube, unilateral salpingectomy was done. Adjuvant platinum-based chemotherapy was added in a case of dysgerminoma, and there has been no sign of recurrence after 3 years.

Laparoscopic Management of Ovarian Dysgerminoma Presenting with Acute Abdomen Caused by Adnexal Torsion in a 17-Year-Old Girl

“…3 For this reason, unilateral salpingooophorectomy could be reasonable for dysgerminoma detected at the early stage by preoperative image diagnostic procedures and intraoperative findings, 11 instead of exploratory laparotomy to remove the mass and determine the extent of the disease by a thorough and systemic exploration of the abdomen and pelvis. Although bilateral involvement is noted in 10% to 20% of dysgerminoma cases, 7 biopsy of the contralateral ovary, which may cause adhesion formation, is not required 1 if the contralateral ovary appears normal as in the present case.…”

“…9,10 In our department, a laparoscopic approach has been the primary surgical intervention selected for over 13 years, if the surgical indication fulfills our criteria for management of adnexal mass. 11 Briefly, in suspicious cases, patients with tumors !10e12 cm that could be retrieved in an endobag are chosen for laparoscopic surgery and the final decision to pursue laparoscopic surgery is made after finally confirming the disease condition, including presence of severe adhesion formation, rupture of the tumor capsule, and apparent metastatic foci under laparoscopic observation. When the laparoscopic procedure is performed for suspicious adnexal mass, spillage of tumor tissue should be minimized by careful manipulation of tumor tissue, because recurrent dysgerminoma was reported at the site of tumor removal after laparoscopic treatment by recovery of tumor tissue through posterior colpotomy without retrieval in an endobag.…”

“…9,10 Furthermore, our previous report showed that selected solid adnexal tumors could be managed by laparoscopic surgery, if tumor spillage can be avoided by retrieving the tumor tissue in an endobag. 11 In the present report, successful laparoscopic management of ovarian dysgerminoma presenting with an acute abdominal emergency due to adnexal torsion is described.…”

Diagnostic Computed Tomographic Angiography and Therapeutic Emergency Transcatheter Arterial Embolization for Management of Postoperative Hemorrhage after Gynecologic Laparoscopic Surgery

“…Procedures for laparoscopic-assisted myomectomy (LAM) [15], laparoscopic-assisted vaginal hysterectomy (LAVH) [16], adnexal surgery [17], and ectopic pregnancy surgery [18] have been reported elsewhere. All patients who received scheduled surgery had preoperatively donated autologous blood in amounts ranging from 400 to 1200 mL [15][16][17], depending on the predicted degree of difficulty during the procedures and this blood was transfused back to the selected patients depending on the amounts of intraoperative bleeding. Further, if massive hemorrhage occurred during surgery, salvage device-based intraoperative autologous blood donation and transfusion were also performed [15,18].…”