Leak-proof extracorporeal drainage for management of large ovarian tumors

Abstract

Minilaparotomy with leak-proof extracorporeal drainage using cyanoacrylate adhesive and polyurethane membrane is reliable, safe, and feasible for management of large ovarian tumors with low probability of malignancy in selected patients.

Fast Leak-Proof, Intraumbilical, Single-Incision Laparoscopic Ovarian Cystectomy for Huge Ovarian Masses: “Hybrid Cystectomy and Reimplantation” Method

“…The surgical approach for large ovarian cysts in young women who desire fertility preservation remains a challenge. We must not only consider maximum preservation of the normal ovary with minimal injury to the vasculature and damage following electrocauterization [ 1 , 6 , 7 , 8 , 9 ] but also minimize the leakage of the cystic contents into the pelvic cavity to decrease the need for copious irrigation [ 11 , 13 , 15 , 17 , 18 ], which increases the total OT, along with making minimal scarring for cosmetic purposes [ 19 , 20 , 22 ].…”

“…They performed extracorporeal suturing using conventional laparotomy instruments at the umbilical level, which is in contrast to our intracorporeal suturing of the ovary in situ. Attached ovarian masses cannot be completely exposed through the port placed within the umbilicus in cases of masses that are not large enough to reach the umbilicus; therefore, Weng et al made a 4 cm skin incision 3 cm above the symphysis pubis and not within the umbilicus [ 17 ].…”

“…However, our proposed method can be applied to ovarian masses irrespective of whether they can be exposed through the umbilical port or not. Extracorporeal cystectomy or oophorectomy for huge ovarian masses has been previously reported [ 11 , 17 , 18 , 19 , 20 ] but these reports were based on mini-laparotomy [ 17 , 18 ] or conventional laparoscopy, which needs an extension of the 5 mm or 10 mm incision of the trocar site for the removal of huge masses [ 11 , 19 , 20 , 22 ]. Recently, a novel technique was introduced for performing intraperitoneal ultrasound scans by culdotomy to guide precise laparoscopic cystectomy for complex ovarian tumors, and in this method, the tumor can be extracted within an endo bag, through the posterior colpotomy [ 23 ].…”

“…In terms of leakage-proof methods for resecting huge ovarian masses, Shozu et al first reported a leakage-proof puncture method for 30 patients with large ovarian masses (range, 5–27 cm; mean, 15 cm) using a polyethylene bag placed directly over the ovarian cyst using cyanoacrylate adhesive and a 3–5 cm mini-laparotomy approach [ 15 ]. Weng et al reported a similar technique using a polyurethane membrane instead of the adhesive and a self-retraining wound retractor using a mini-laparotomy approach in 20 patients with large ovarian tumors (range, 10–26 cm; mean, 15 cm) [ 17 ]. A 4 cm skin incision was placed 3 cm above the symphysis pubis, and salpingo-oophorectomy was performed extracorporeally.…”

“…However, these methods have limited scope in some cases, such as when the pelvic masses have solid or a non-aspirable cystic content; when there is a multicystic ovarian mass with thick septations; or the masses are not large enough to access at the level of the umbilicus incision made for the multi-channel single-port platforms [ 11 ]. Furthermore, some methods describe oophorectomy, and not cystectomy, even in cases where preservation of ovarian function and fertility is desired in young women [ 17 , 18 ].…”