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Laparoscopic conservative excision of ovarian dermoid cysts with and without an endobag
1Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
Study Objective:
To compare outcomes of conservative laparoscopic treatment of dermoid cysts removed from the abdominal cavity without (group A) and with an endobag (group B).
Design:
Prospective, randomized, 4-year (June 1992-June 1996) study (Canadian Task Force classification I).
Setting:
Department of Obstetrics and Gynecology of the Catholic University of the Sacred Heart in Rome.
Patients:
Fifty-five premenopausal women with dermoid cysts. Intervention. Patients were randomly assigned to removal of dermoid cysts from the abdominal cavity with or without an endobag through a 10- to 12-mm cannula sleeve.
Measurements And Main Results:
We assessed surgical time, spillage, complications, length of hospitalization, recurrences, and pregnancies. In the 55 women, 58 dermoid cysts (mean diameter 5.6 +/- 2.03 cm) were enucleated and removed at operative laparoscopy through a 10- to 12-mm cannula sleeve without intraoperative or postoperative complications. Mean operating time was 73 minutes. When cysts were removed with an endobag, operating time was significantly reduced over removal without the endobag (63 vs 81 min, p <0.05). Obvious spillage of endocystic contents occurred in 13 (43.3%) patients in group A but in only 1 patient in group B because the bag ruptured (p <0.05). No signs or symptoms of peritonitis were observed in women with evident cystic spillage or in those in group A in whom spillage was possible. Average postoperative hospital stay was 1.7 days and did not differ between groups. Among 20 infertile women, 9 (45%) experienced spontaneous pregnancy within a year, with no differences between groups. Echographic follow-up did not reveal cyst recurrence.
Conclusions:
Laparoscopic conservative cystectomy of dermoid cysts in premenopausal women is safe and effective and appears to be a valuable alternative to laparotomy. Removing cysts in an endobag significantly reduced both operating time and spillage. However, controlled intraperitoneal spillage of cyst contents does not increase postoperative morbidity as long as the peritoneal cavity is thoroughly washed.