A minimally invasive technique for management of the large adnexal mass

To describe our experience managing large pelvic masses through a minilaparotomy incision using a flexible, self-retaining wound retractor and exteriorized drainage by application of 2-octyl cyanoacrylate and a thin polyurethane membrane.

Prospective nonrandomized trial (Canadian Task Force classification II-1).

Academic university hospital.

Ten women undergoing minilaparotomy for adnexal masses.

After obtaining institutional review board approval, we identified 10 patients who underwent minilaparotomy for treatment of adnexal masses not thought to be amenable to laparoscopic surgical management and with clinical, radiographic, and laboratory evaluation consistent with a low probability of malignancy. Charts were reviewed and data collected.

The median mass size was 17.5 cm (range 9-30 cm), median incision length was 4.0 cm (range 3-5.5 cm), median patient age was 29.5 years (range 19-41 years), median body mass index was 24.7 (range 19.4-30.7), median duration of surgery was 85 minutes (range 53-141 minutes). Blood loss was minimal in all cases and all patients were discharged on the day of surgery. There were no diagnoses of ovarian malignancy. Pathologic diagnoses included mature cystic teratomas, cystadenomas, and cystadenofibromas. There were no instances of intraabdominal leakage of cyst fluid. One patient required readmission for a postoperative ileus.

Minimally invasive management is a reasonable alternative to traditional laparotomy in the setting of a large adnexal mass with low probability of malignancy. This technique allows adequate access and exposure while minimizing the risk of intraabdominal contamination, speeding patient recovery, and optimizing cosmetic results. Further, this approach can be converted to a laparoscopic staging procedure if a patient is found to have ovarian cancer.