Laparoscopic Conservative Cystectomy of Ovarian Benign Cystic Teratoma

Laparoscopic surgery has almost totally replaced laparotomy in the management of benign adnexal conditions. Benign cystic teratoma (dermoid cyst) is one of the most common ovarian neoplasms in young women. A prospective non-randomized clinical trial was conducted. To compare the efficacy of two different methods of removal of benign cystic teratoma enucleated laparoscopically. Between January 1991 and June 1993, 37 women, all reproductive-age and desiring future fertility, underwent resection of dermoid cysts between 4 and 8 cm in diameter via laparoscopy using the three-puncture-technique. The removal of the cysts from the abdominal cavity was carried out by traction through an extended incision of one of the puncture sites in the first 17 cases (group A), and the other 20 cases (group B) were managed by embedding the cyst in a plastic bag inserted through one of the trocars, aspirating its contents, and subsequent extraction of the bag without extension of abdominal wall stab wounds. The operating time in both groups was comparable (from 35-130 minutes in group A, and 45-120 minutes in group B. However, the time required for removal of the cyst from the abdominal cavity was significantly shorter in group B (10-15 minutes) compared with group A (20-35 minutes). Spillage of cyst contents occurred in six cases in group A, and in two cases in group B. The average hospital stay in both groups was similar (22.8 hours in group A and 23.4 hours in group B). Postoperative complications in group A included one case of excessive bleeding from the extended incision, and three cases of wound infection. None of the patients in group B had short- or long-term postoperative complications. Operative laparoscopy is a safe and effective method in the management of benign cystic teratoma. We found that removal of the enucleated cyst from the abdominal cavity using a plastic bag is advantageous in terms of operating time and postoperative complication as well as in the cosmetic results compared to extraction of the cyst through an extended abdominal incision.