Seven-liter ovarian cyst in an adolescent treated by minimal access surgery: laparoscopy and open cystectomy

Abstract

Laparoscopic approaches to giant ovarian cysts, particularly in adolescents, have critical management concerns as follows: risk of malignancy, risk of cyst rupture, and limited working space. A 15-year-old girl presented with a giant (N25 cm) ovarian serous cyst adenoma containing 7 L of fluid. At open laparoscopy, a giant, entirely cystic, smooth mass originating from the right ovary and lying between the symphysis and the xiphoid was observed. After intraabdominal fluid aspiration, open conservative cystectomy was performed, avoiding spillage. The patient made an uneventful postoperative recovery and was discharged on the second postoperative day. To our knowledge, this is the largest ovarian cyst treated conservatively in an adolescent. Minimal access surgery, laparoscopy and open cystectomy, can be safely proposed in this group of patients. Conservative surgery should always be evaluated for preservation of ovarian function in cases of giant ovarian cysts in adolescents. Published by Elsevier Inc.Large ovarian cysts in adolescents may present as a challenge to gynecologists. The patient's age, menstrual status, the size and structure of the cyst, risk of malignancy, and symptoms are critical in choosing treatment strategies.Laparoscopy represents the gold standard approach for the treatment of ovarian cysts. In the adolescent population, laparoscopy may be difficult, particularly when the cysts' sizes extend to the umbilicus because of limited working space, risk of rupture, and perioperative problems related to cardiorespiratory function [1].Currently, many treat large ovarian cysts in adolescents by ovariectomy, whereas a few try laparoscopic cystectomy after aspiration of the cyst (blindly or under ultrasound [US] guidance). These techniques do not rule out the risk of spillage and do not allow the surgeon to inspect the peritoneal cavity and the posterior cyst wall properly, which is considered a very important precaution to take before performing a cystectomy [2].We present a case of a 15-year-old virgin girl with a giant ovarian cyst that was treated by minimal access surgery, laparoscopy and open cystectomy.

Transumbilical 1-port laparoscopic resection of benign ovarian tumor

“…One report showed that intraoperative tumour spillage occurred in 27 (52%) patients, but there were no cases of chemical peritonitis as well as tumor recurrence [11]. In this study, we also aspirated the cyst under a direct laparoscopic view, which is reported to be safer because it allows the assessment of the abdominal cavity and ovarian cyst, thus limiting the risk of spillage [12]. Despite no gross intraoperative spillage, we did not prevent minor, inconspicuous leakage.…”

Pure laparoscopic management of a giant ovarian cyst in an adolescent

“…Although ovarian cysts enlarging to immense dimensions are typically of benign nature, excluding any possibility of malignancy during the preoperative period is of utmost importance [5]. A restricted operating field (particularly in children), the probability of malignancy, and tendency of the cyst to rupture are critical considerations in the laparoscopic approach to these cysts [6,7]. To date, the acknowledged management modalities include: the percutaneous drainage of the cyst under ultrasonographic guidance, decompression of the cyst with the aid of minilaparotomy and its excision, and laparoscopic excision of the cyst after its ultrasound-guided drainage [1,7,8].…”

“…A restricted operating field (particularly in children), the probability of malignancy, and tendency of the cyst to rupture are critical considerations in the laparoscopic approach to these cysts [6,7]. To date, the acknowledged management modalities include: the percutaneous drainage of the cyst under ultrasonographic guidance, decompression of the cyst with the aid of minilaparotomy and its excision, and laparoscopic excision of the cyst after its ultrasound-guided drainage [1,7,8]. Drainage of the cyst under ultrasonographic guidance is associated with some complications, the most predominant being the potential leakage of the cyst contents into the abdominal cavity in cases of malignancy.…”

Single-Port Transumbilical Laparoscopic-Assisted Adnexal Surgery

“…5 If cystectomy was performed, the cyst was drained preoperatively by suprapubic catheter or under ultrasonographic guidance. 4,6 Another group 7 reported treatment of a giant ovarian cyst in an adolescent patient, and those authors chose aspiration under laparoscopic visualization, because it allows assessment of the pelvic cavity and ovarian cyst before cyst puncture, thus, limiting the risk of spillage that cannot be avoided by aspiration under ultrasonographic guidance. However, they extracted the cyst through a 2-cm suprapubic incision.…”