Management of Large Pediatric and Adolescent Ovarian Neoplasms with a Leak-Proof Extracorporeal Drainage Technique: Our Experience Using a Hybrid Minimally Invasive Approach

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 ].…”

“…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 cases of adhesions noted around ovarian cysts, especially in cases of endometrioma, adhesiolysis with monopolar scissors is used to free the ovarian mass before putting it in the endo-bag. However, in cases of very large ovarian masses that could not fit in even an extra-large endo-bag, the size of the mass is decreased using a technique reported previously [ 11 , 14 , 18 , 19 ]; thereafter, the reduced ovarian mass is placed in the endo-bag. This technique includes placing a purse-string suture on the surface of the ovary and inserting the OSCHNER trocar into the mass through the circle of the purse-string sutures to drain the cystic contents as described in previous reports [ 11 , 18 , 19 , 20 ].…”

“…However, in cases of very large ovarian masses that could not fit in even an extra-large endo-bag, the size of the mass is decreased using a technique reported previously [ 11 , 14 , 18 , 19 ]; thereafter, the reduced ovarian mass is placed in the endo-bag. This technique includes placing a purse-string suture on the surface of the ovary and inserting the OSCHNER trocar into the mass through the circle of the purse-string sutures to drain the cystic contents as described in previous reports [ 11 , 18 , 19 , 20 ]. When there is nothing left to be drained (such as in case of blockage of the suction system due to thick fat, hair, scalp, or bone-in a teratoma or thick septum in a multiseptated mucinous cyst), the suture is tied while simultaneously withdrawing the OSCHNER trocar out of the cyst to seal the trocar insertion site to prevent the spillage the cystic contents ( Figure 2 ).…”

“…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 ].…”