Yonsei Med J.  2019 Sep;60(9):864-869. 10.3349/ymj.2019.60.9.864.

Laparoendoscopic Single Site Surgery for the Treatment of Huge Ovarian Cysts Using an Angiocatheter Needle

Affiliations
  • 1Department of Obstetrics and Gynecology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea. bitsugar@catholic.ac.kr

Abstract

PURPOSE
The aim of this study was to evaluate the feasibility and safety of laparoendoscopic single site (LESS) surgery using an angiocatheter needle in patients with huge ovarian cysts (diameter ≥15 cm).
MATERIALS AND METHODS
Thirty-one patients with huge ovarian cysts underwent LESS surgery using an angiocatheter needle between March 2011 and August 2016. An intra-umbilical vertical incision (1.5-2.0 cm) was made in the midline. After the cyst wall was punctured using an angiocatheter needle, the fluid contents were aspirated with a connected vacuum aspirator. After placing a Glove port in the umbilical incision, LESS surgery was performed using a rigid 0-degree, 5-mm laparoscope and conventional, rigid, straight laparoscopic instruments. Knife-in-bag morcellation was instituted for specimen collection.
RESULTS
The median maximal diameter of ovarian cysts was 18 cm (range, 15-30 cm), the median operation time was 150 minutes (range, 80-520 minutes), and the median volume of blood loss was 100 mL (range, 20-800 mL). Three patients (9.7%) were diagnosed with malignant ovarian cancer using intraoperative frozen examination, and 1 patient was converted to laparotomy due to advanced disease. Thirty patients underwent LESS, and there was no need for an additional laparoscopic port.
CONCLUSION
LESS surgery using an angiocatheter needle, with leaving only a small postoperative scar, was deemed feasible for the management of huge ovarian cysts.

Keyword

Huge ovarian cyst; LESS surgery; feasibility; safety

MeSH Terms

Cicatrix
Female
Humans
Laparoscopes
Laparotomy
Morcellation
Needles*
Ovarian Cysts*
Ovarian Neoplasms
Specimen Handling
Vacuum

Figure

  • Fig. 1 Technique of laparoendoscopic single-site (LESS) surgery using an angiocatheter needle for extremely huge ovarian cysts. (A) A large ovarian cyst through a vertical 1.5- to 2.0-cm incision in the umbilical area is shown. (B) An angiocatheter needle connected to a suction line is used to puncture the cyst and aspirate the cyst contents. (C) After cystic contents are aspirated, both ends of the cyst wall are clamped using Kelly clamps. A 5-mm suction tip is inserted after the incision in the puncture hole is extended. (D) After complete suction, the puncture hole of the cyst is closed by purse string suture with 2-0 Vicryl to prevent spillage during LESS surgery. (E) The decompressed ovarian cyst is shown through a Glove port in the intraabdominal cavity. (F and G) After LESS cystectomy or adnexectomy, a huge ovarian tissue is extracorporeally removed by knife-in-bag morcellation through the umbilicus. (H and I) Upon discovery of borderline or malignant tumor in a frozen section, the patient underwent surgical staging.


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