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Laparoscopic Cystectomy In-a-Bag of an Intact Cyst: Is It Feasible and Spillage-Free After All?

Detorakis S, Vlachos D, Athanasiou S, Grigoriadis T, Domali A, Chatzipapas I, Stamatakis E, Mousiolis A, Patrikios A, Antsaklis A, Loutradis D, Protopapas A - Minim Invasive Surg (2016)

Bottom Line: Minimal small spillage occurred despite every effort only in 8/110 (7.2%) cases with large (>8 cm) cystic teratomas.There were no intraoperative or postoperative complications.We concluded that laparoscopic cystectomy in-a-bag of an intact cyst is feasible and oncologically safe for cystic tumors with a diameter < 8 cm.

View Article: PubMed Central - PubMed

Affiliation: 1st Department of Obstetrics and Gynecology of the University of Athens, Alexandra Hospital, 80 Queen Sophie Avenue and Lourou Street, 11528 Athens, Greece.

ABSTRACT
This prospective study was conducted to assess the feasibility of laparoscopic cystectomy of an intact adnexal cyst performed inside a water proof endoscopic bag, aiming to avoid intraperitoneal spillage in case of cyst rupture. 102 patients were recruited. Two of them were pregnant. In 8 of the patients the lesions were bilateral, adding up to a total of 110 cysts involved in our study. The endoscopic sac did not rupture in any case. Mean diameter of the cysts was 5.7 cm (range: 2.3-10.5 cm). In 75/110 (68.2%) cases, cystectomy was completed without rupture, whereas in the remaining 35/110 (31.8%) cases the cyst ruptured. Minimal small spillage occurred despite every effort only in 8/110 (7.2%) cases with large (>8 cm) cystic teratomas. There were no intraoperative or postoperative complications. We concluded that laparoscopic cystectomy in-a-bag of an intact cyst is feasible and oncologically safe for cystic tumors with a diameter < 8 cm. Manipulation of larger tumors with the adnexa into the sac may be more difficult, and in such cases previous puncture and evacuation of the cyst contents should be considered.

No MeSH data available.


Related in: MedlinePlus

Probabilities of rupture with and without spillage in relation to MCD (cm).
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Related In: Results  -  Collection


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fig2: Probabilities of rupture with and without spillage in relation to MCD (cm).

Mentions: The mean MCD of the cysts that ruptured independent of spillage was 6.75 cm and the mean MCD of those without rupture was 5.60 cm. This difference was statistically significant (p < 0.001). In the group of patients with rupture but no spillage the MCD was 6.10 cm and did not differ significantly compared with that of the no-rupture group. When attempting to determine a cutoff point of the MCD above which the probability of rupture (with or without spillage) increases significantly, this was set at 7.3 cm. Among ovarian cysts with a MCD ≥ 7.3 cm 57.7% (15/26) ruptured, compared with 23.8% (20/84) of those with a MCD < 7.3 cm (p = 0.003). The relative risk (RR) of rupture was 4.36 times greater for cysts with MCD ≥ 7.3 cm than for those with MCD < 7.3 cm (Figure 2).


Laparoscopic Cystectomy In-a-Bag of an Intact Cyst: Is It Feasible and Spillage-Free After All?

Detorakis S, Vlachos D, Athanasiou S, Grigoriadis T, Domali A, Chatzipapas I, Stamatakis E, Mousiolis A, Patrikios A, Antsaklis A, Loutradis D, Protopapas A - Minim Invasive Surg (2016)

Probabilities of rupture with and without spillage in relation to MCD (cm).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4821967&req=5

fig2: Probabilities of rupture with and without spillage in relation to MCD (cm).
Mentions: The mean MCD of the cysts that ruptured independent of spillage was 6.75 cm and the mean MCD of those without rupture was 5.60 cm. This difference was statistically significant (p < 0.001). In the group of patients with rupture but no spillage the MCD was 6.10 cm and did not differ significantly compared with that of the no-rupture group. When attempting to determine a cutoff point of the MCD above which the probability of rupture (with or without spillage) increases significantly, this was set at 7.3 cm. Among ovarian cysts with a MCD ≥ 7.3 cm 57.7% (15/26) ruptured, compared with 23.8% (20/84) of those with a MCD < 7.3 cm (p = 0.003). The relative risk (RR) of rupture was 4.36 times greater for cysts with MCD ≥ 7.3 cm than for those with MCD < 7.3 cm (Figure 2).

Bottom Line: Minimal small spillage occurred despite every effort only in 8/110 (7.2%) cases with large (>8 cm) cystic teratomas.There were no intraoperative or postoperative complications.We concluded that laparoscopic cystectomy in-a-bag of an intact cyst is feasible and oncologically safe for cystic tumors with a diameter < 8 cm.

View Article: PubMed Central - PubMed

Affiliation: 1st Department of Obstetrics and Gynecology of the University of Athens, Alexandra Hospital, 80 Queen Sophie Avenue and Lourou Street, 11528 Athens, Greece.

ABSTRACT
This prospective study was conducted to assess the feasibility of laparoscopic cystectomy of an intact adnexal cyst performed inside a water proof endoscopic bag, aiming to avoid intraperitoneal spillage in case of cyst rupture. 102 patients were recruited. Two of them were pregnant. In 8 of the patients the lesions were bilateral, adding up to a total of 110 cysts involved in our study. The endoscopic sac did not rupture in any case. Mean diameter of the cysts was 5.7 cm (range: 2.3-10.5 cm). In 75/110 (68.2%) cases, cystectomy was completed without rupture, whereas in the remaining 35/110 (31.8%) cases the cyst ruptured. Minimal small spillage occurred despite every effort only in 8/110 (7.2%) cases with large (>8 cm) cystic teratomas. There were no intraoperative or postoperative complications. We concluded that laparoscopic cystectomy in-a-bag of an intact cyst is feasible and oncologically safe for cystic tumors with a diameter < 8 cm. Manipulation of larger tumors with the adnexa into the sac may be more difficult, and in such cases previous puncture and evacuation of the cyst contents should be considered.

No MeSH data available.


Related in: MedlinePlus