Obstet Gynecol Sci.  2017 Mar;60(2):178-186. 10.5468/ogs.2017.60.2.178.

Surgical technique for single-port laparoscopy in huge ovarian tumors: SW Kim's technique and comparison to laparotomy

• Kim JS
• Lee IO
• Eoh KJ
• Chung YS
• Lee I
• Lee JY
• Nam EJ
• Kim S
• Kim YT
• Kim SW

• KMID: 2372802
• DOI: http://doi.org/10.5468/ogs.2017.60.2.178

Abstract

OBJECTIVE
This study aimed to introduce a method to remove huge ovarian tumors (≥15 cm) intact with single-port laparoscopic surgery (SPLS) using SW Kim's technique and to compare the surgical outcomes with those of laparotomy.
METHODS
Medical records were retrospectively reviewed for patients who underwent either SPLS (n=21) with SW Kim's technique using a specially designed 30×30-cm²-sized 3XL LapBag or laparotomy (n=22) for a huge ovarian tumor from December 2008 to May 2016. Perioperative surgical outcomes were compared.
RESULTS
In 19/21 (90.5%) patients, SPLS was successfully performed without any tumor spillage or conversion to multi-port laparoscopy or laparotomy. There was no significant difference in patient characteristics, including tumor diameter and total operation time, between both groups. The postoperative hospital stay was significantly shorter for the SPLS group than for the laparotomy group (median, 2 [1 to 5] vs. 4 [3 to 17] days; P<0.001). The number of postoperative general diet build-up days was also significantly shorter for the SPLS group (median, 1 [1 to 4] vs. 3 [2 to 16] days; P<0.001). Immediate post-operative pain score was lower in the SPLS group (median, 2.0 [0 to 8] vs. 4.0 [0 to 8]; P=0.045). Patient-controlled anesthesia was used less in the SPLS group (61.9% vs. 100%).
CONCLUSION
SPLS was successful in removing most large ovarian tumors without rupture and showed quicker recovery and less immediate post-operative pain in comparison to laparotomy. SPLS using SW Kim's technique could be a feasible solution to removing huge ovarian tumors.

Keyword

Laparoscopy; Ovarian cysts; Single port

MeSH Terms

Anesthesia
Diet
Female
Humans
Laparoscopy*
Laparotomy*
Length of Stay
Medical Records
Methods
Ovarian Cysts
Retrospective Studies
Rupture

Figure

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  Fig. 1 A specifically designed 30×30-cm2-sized laparoscopic specimen retrieval bag (3XL LapBag, Sejong Medical Co., Seoul, Korea).

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  Fig. 2 Intraoperative view of single-port laparoscopic surgery in a patient with a large left ovarian cyst tumor. (A) A 22-cm left ovarian cystic tumor (T) is occupying the entire lower abdominal cavity in supine position. (B) In the Trendelenburg position, the tumor goes into the upper abdominal cavity, and the uterus (arrow) and left infundibulopelvic ligament are exposed. (C) The left infundibulopelvic ligament is ligated and dissected with a LigaSure. (D) The left utero-ovarian ligament and fallopian tube are ligated with a LigaSure.

• 

  Fig. 3 SW Kim's technique for placing a large tumor in a laparoscopic bag (3XL LapBag). After completing salpingo-oophorectomy, the ovarian tumor is located into the pelvic cavity by changing the patient's position into reverse Trendelenburg position. Then insert the 3XL LapBag into the pelvic cavity. After unfolding the 3XL LapBag above the tumor, the bag is taken into the upper abdominal cavity. The bag opening is made into a triangular shape by holding three apexes by graspers. (A) For holding the bilateral bottom corner of the bag, needle holders are used to grasp the bag because it can firmly hold the bag without loosening. The lower edge is positioned under the ovarian tumor. (B) Transverse view: the lower edge is held with two needle holders and positioned under the ovarian tumor. (C) The center of the upper edge of the bag is held with a grasper and the opening is made into a triangular shape. The bag opening is placed on the cranial portion of the tumor and pulled over the ovarian tumor while the patient is changed into Trendelenburg position. (D) In Trendelenburg position, the bag is pulled over the tumor, which falls into the bag because of gravity.

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  Fig. 4 Intraoperative view of SW Kim's technique for placing a large tumor in a laparoscopic bag (3XL LapBag). (A) A 3XL LapBag is inserted into the lower abdominal cavity and unfolded over the tumor (T). (B) The left bottom corner of the bag is held with a needle holder. (C) The right bottom corner of the bag is held with a needle holder and the tumor is goes into the bag by moving the patient into the Trendelenburg position. (D) The tumor is placed in the bag (arrow: uterus).

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  Fig. 5 (A) A large ovarian cystic tumor is occupying the lower abdominal cavity (T2 magnetic resonance image). (B) Gross finding of a large ovarian cystic tumor after retrieval using a 3XL LapBag. Lt, left.

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