[Surgical laparoscopy in tumors of the adnexa]

The laparoscopic management of adnexal masses is still controversial. The main problems are preoperative diagnosis, operative technique and the possibility of compromising the prognosis by spillage of cancer cells when operating on a hitherto unrecognized early stage ovarian cancer. We report on our experience with minimal invasive surgery of adnexal masses.

From June 1989 to July 1992, 375 patients underwent surgery for adnexal tumors at the University Hospital, Zurich. In 112 cases a laparoscopic operation was performed. The indications were unilateral or bilateral masses in the adnexal region with or without clinical symptoms. The preoperative workup included patient's history, clinical examinations, vaginal sonography and intraoperative evaluation of the tumor.

In 72% (83) of cases the organs were preserved by the laparoscopic procedure while in 28% (32) salpingo-oophorectomy, ovariectomy or salpingectomy was performed. The histopathologic findings included cystadenomas, cystadenofibromas, benign cystic teratomas, simple and functional cysts, mesothelium cysts, tubo-ovarian abscesses, endometriomas, and torqued tubes and/or ovaries. In no patient was a malignant process found. Only one postoperative complication was noted in a patient who had to be relaparoscoped due to adhesions to the operated ovary. One recurrence occurred in a hydrosalpinx.

Adnexal masses may safely be managed laparoscopically, with all the advantages of minimal invasive surgery, provided that strict diagnostic and therapeutic rules are observed.