what are key points to be kept in mind when embarking on very huge benign ovarian cyst extended into the abdomen when doing laparoscopically ?? Thanks
I think it is not a good idea to manage a huge ovarian cyst laparoscopically. Firstly, you can not rule out its malignant nature completely before definitive hystopathologic confirmation. Second, it is better to take off the lesion without spillage of fluid into the peritoneum. Lastly, a big cyst interferees with the laparoscopic space, leading to difficult manoeuvers that would much more confortable in the open manner. In conclusion, I strongly avoid the management of any "huge" mass by the laparoscopic approach.
@Lapo bencini
I appreciate you took time to answer. I agree with you on your points.
What i am personally inclined to just to peak inside the abdomen and see whats going on there. But yes, low threshold should be kept for conversion.
Somebody if he/she can enlighten me on the risk of spillage of cyst contents if that turns out to be malignant at histopathology??
@michael Al boghdady
Sir, ct scan done which showed 15× 20× 18 cm mass, mostly cystic component. CA 125 report awaited.
@michael Al boghdady
Thankyou so much for your support and guidance
If the benignity of the cyst has been confirmed, there should be no difficulty in laparoscopic resection. I have little, but positive experience in this regard
in my opinion, if no any doubt and evidence of malignancy of cyst, I think laparoscopic resection can be more benefit for patient an surgeon, any way, good luck
If you state "a huge" ovarian cyst or "giant" cyst, I do not think to a maximum diameter of less than 20 cms. In this case I do confirm that an attempt of laparoscopy should be made routinely. On the other hands, I consider a "huge" cyst as larger mass up to 40 or 50 cm that rarely could be approached ilaparoscopically due to spatial occupation. Moreover, if you want to manage such a giant cyst by laparoscopy, you should take care of aspiration to avoid spillage.
Hi dear the most important thing is to be sure that the cyst is benign, otherwise no thing is difficult laparoscopically.
I agreed with Dr. de la Cruz. We had similar experiences. in larger cyst.
We removed the specimen via colpotomy .
RE: video presentation at AAGL meeting
If it is benign Huge Ovarian cyst I have experience such case the ports should be at higher sites and I did Aspiration by Laparoscopic needle then excision of the cyst
Regards
Interesting point. What are the chances of a huge ovarian cyst for being malignant? Can somebody enlighten me here? What benign ovarian cyst contents can be dangerous when spilled in peritoneal cavity or every benign cyst has potency of implantation cyst in peritoneum?
The above scenario is very suitable for Laparoscopy.I agree with Dr Michael.If there is a space constraint in a Benighn looking cyst on CT,u/s guided decompression followed by Laparoscopy is the alternative.
An excellent discussion with excellent answers. I've had quite a good experience with theses cases over the years. Yes they can be managed laparoscopically as long as the benign nature can be proved beyond reasonable doubt (as mentioned above by other colleagues). During surgery, there is always a danger of adherence to the sigmoid colon and/or small bowel. This has to be anticipated. Also, conversion rate in these cases are higher than in removal of smaller cysts.