The Method Minimizing the Spillage on Laparoscopic Cystectomy of Ovarian Dermoid Cyst

Oh, Sung Tack; Lee, Jee Young

Abstract

This study was to evaluate the efficacy of new technique to minimize the spillage during laparoscopic dermoid cystectomy. This study used the data gained from 70 patients who were diagnosed to benign dermoid cyst by ultrasonography, MRI, CT, diagnostic laparoscopy. In 29 patients whose cysts were very serous and had much fluid, ovarian serosa was incised by needle bovie and serosa was separated from cyst wall. After then aspiration of content by perforemed and puncture site was sutured. Cyst wall was stripped, and removed by endopouch. By this method, operation was performed without spillage in 26 of 29 patients(89.7%). Small rupture was occured in 3 patients(10.3%), but suction of rupture site was done immediately and sutured. 2000 cc of saline was needed for washing, and mean operation duration was 1.5+/-0.4 hours. In 41 patients whose cysts were sebaceous and had much solid part, ovarian serosa was incised by needle bovie and cyst wall was separated from ovary without aspiration. Separated cyst was removed by same manner. By this method, operation was performed without any spillage only in 23 of 41 patients(56.1%). Small rupture was occured in 14 of 41 patients(34.1%), but dropping was also prevented. By that, cystectomy with very few soillage was also possible. Realtively large rupture was occured in 4 of 41 patients(9.8%) and small content was spread in peritoneum, but rupture site was sutured and more spread was prevented. By this, even in these 4 patients need only 5000 cc of saline for complete washing. Mean operation duration was 2.4+/-0.8 hours. Therefore preoperative sonographic evaluation of fluid part and these new operation methods seems to be very helpful on pelviscopic cystectomy for dermoid cyst with minimal intraperitoneal spillage of content.