Minilaparotomy a Good Option in Specific Cases: A Case Report of Bilateral Ovarian Germ Cell Tumor

Abstract

Mature cystic teratomas (MCTs) of the ovary represent 44% of ovarian neoplasmas. The surgical approach is important in young women especially for the cosmetic results. Nowadays most of the ovarian surgeries can be performed laparoscopically. An alternative between laparoscopy and laparotomy is the minilaparotomy (ML) which can be an interesting option, thanks to the small incision. We report a 39-year-old woman who was referred to our hospital with acute abdominal pain. In her past history the patient had an uncomplicated delivery. During pregnancy a 6 cm bilateral MCT was diagnosed and expectant management was followed. A left-sided ovarial torsion was postulated, and laparoscopic detorsion was performed. To avoid a rupture of the left MCT, the operation was interrupted. To remove the cyst, a ML was done two weeks later. A left-sided salpingo-oophorectomy was performed due to a large cyst including the entire ovary. On the other side, the right dermoid cyst was entirely removed. The advantage of a ML is not only shorter operating time with less learning curve compared to laparoscopy but also the possibility to extract the adnexal mass from the abdominal cavity with lower risk of rupture and in addition the possibility to preserve more ovarian tissue.

Embriology of Dermoid Cysts With Neuro-Ectodermal Content

“…We present findings found in ovarian cystic formation of patient in fertile age removed by operative laparoscopy [1,8,9].…”

“…Thus, the mix of tissue formed as such derived from different embryonic structures serve to store a dermoid cysts [1,2,3,4].…”

A Rare case of Benign Dermoid Cystic Teratoma of Ovary Infiltrating Urinary Bladder

“…In managing the cases of dermoid ovarian cysts, the surgical approach remains very important especially if the patient is young women in whom fertility has to be retained (9). Nowadays, the most preferred surgical approach is laparoscopy, but there hare good number of them who consider a minilaparotomy as the preferred procedure (10). Anyway, the complete enucleation of the masses avoiding rupture during surgical procedure is very essential as recurrence of a dermoid cyst may sometimes take place due the incomplete enucleation (9).…”

Surgical Management of an Ovarian Bilateral Multiple Dermoid Cyst During Pregnancy: A Case Report Study

“…Mini laparotomy is another alternative between laparoscopy and laparotomy. Shorter operation time, removal of the mass with lower risk of rupture and preserving more ovarian tissue are some advantages of this approach in comparison to laparoscopy (7). In the selected cases of adnexal mass during pregnancy, close observation is an accepted alternative to surgery in patients with an adnexal mass (8).…”