Management of ovarian cysts by laparoscopic extracorporeal approach using single ancillary trocar

This prospective study aimed to evaluate an alternative laparoscopic extracorporeal approach for the treatment of benign ovarian cysts.

The initial study population included 243 patients diagnosed with benign ovarian masses. Two patients with suspected malignancies and 21 patients with technical difficulties secondary to severe, dense pelvic adhesions were excluded from the study, and the final study population, therefore, comprised 220 patients. A primary 10-mm trocar was inserted, followed by a second incision on the side of the cyst and the introduction of an ancillary 5-mm trocar. The cystic content was aspirated using a needle. The capsule was held using an endograsper inserted through the ancillary trocar. The capsule was extracted from the abdomen. The 5-mm trocar and the endograsper were removed from the abdomen simultaneously. The capsule was completely detached. Homeostasis was performed and the ovary was then released.

The mean duration of the operation was 20 +/- 5 minutes. The size of the cysts ranged from 5 cm to 15 cm (mean, 8.4 +/- 2.6 cm). The pathologies of the cysts were simple cyst in 86 cases, endometrioma in 68, serous cyst in 57, mucinous cyst in eight and borderline in one. The perioperative complication rate was 2.27%.

This technique does not require the use of two or more ancillary trocars or widening of the trocar incision. The duration of surgery can be shortened considerably and complete excision of the cystic capsule can be performed. Homeostasis was achieved using 3-0 polyglactin sutures. No electrocoagulation was required.