Laparoscopic management of benign ovarian disease

There was little controversy in the management of ovarian cysts until 15 years ago when operative endoscopy gained popularity. Before this time, laparotomy was the standard form of treatment for pelvic masses. Simple cysts were treated laproscopically by aspiration and solid or large tumors with any malignant potential by laparotomy. Constantly improving technology and instrumentation has allowed more and more operations to be performed laparoscopically. The gynecological oncologist has been wary of adopting this form of surgery for potential gynecological malignancies because of the safety and efficacy issues. Pelvic pathology, particularly ovarian tumors, pose a difficult problem. Apart from difficulty in screening, it is also difficult to confirm the nature of an ovarian pathology using the currently available investigative modalities. If the nature of an ovarian cyst can be ascertained beyond doubt, then the treatment can be simple, laparoscopy for benign and laparotomy for malignant. Having said that, more enthusiastic operative laparoscopists are using this approach to treat gynecological malignancies. We discuss the role of laparoscopy in the management of ovarian cysts.