Geburtshilfe Frauenheilkd 2006; 66 - PO_K_04_07
DOI: 10.1055/s-2006-952768

Seven year experience in laparoscopic dissection of intact ovarian dermoid cysts.

A Kavallaris 1, O Camara 1, I Georgiev 1, IB Runnebaum 2
  • 1Klinik für Frauenheilkunde und Geburtshilfe, Universität Jena, Jena
  • 2Klinik für Frauenheilkunde und Geburtshilfe der Friedrich-Schiller-Universtität Jena, Jena

Aims: Intraperitoneal spillage of dermoid cyst content, if not followed immediately by abundant peritoneal lavage, can cause a chemical peritonitis with subsequent adhesion formation. STUDY Objective: To evaluate outcomes of minimal laparoscopic treatment of dermoid cysts removed from the abdominal cavity with an endobag. Patients and methods: retrospective, 7-year (September 1999-January 2006) study. The laparoscopic technique included: dissection of the cyst by a combination of a bipolar clamp and a scissor and extraction of the cyst after its placement inside a laparoscopic bag. 121 premenopausal women with dermoid cysts were analyzed. We assessed surgical time, spillage, complications, length of hospitalization, recurrences, and pregnancies. In the 121 women, 127 dermoid cysts (range 3 to 12 cm) were enucleated and removed at operative laparoscopy through a 10-mm Trocar without intraoperative or postoperative complications. Mean operating time was 68 minutes (range 40 to 180 min). In 44 (36,4%) patients the cyst was ruptured were enucleated. Obvious spillage of endocystic contents occurred in 3 (2, 5%) patients because the bag ruptured. No signs or symptoms of peritonitis were observed in women with evident cystic spillage or in patients without cystic spillage. Average postoperative hospital stay was 6.7 days. Operative followup second laparoscopy was available in 35 of the 121 patients: In 9 (7,4%) patients because of dermoid cysts on the contraleteral ovary, in 4 (3,3%) patients because of recurence. In 9 (7,4%) patients experienced spontaneous pregnancy in the last 7 years. Conclusions: Laparoscopic cystectomy of dermoid cysts 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.