Excision of large cystic ovarian tumors: combining minimal invasive surgery techniques and cancer surgery-the best of both worlds

Peter F. Ehrlich, Daniel H. Teitelbaum, Ronald B. Hirschl, Frederick Rescorla

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background/Purpose: Cystic ovarian lesions can be massive, and preoperative evaluations can often not distinguish benign from malignant tumors. Up to 57% of malignant ovarian tumors have a cystic component. We present an approach to these neoplasms that adheres to oncologic principles using minimally invasive techniques. Methods: A 5-cm Pfannensteil incision is performed followed by peritoneal washings. The mass is identified and dried. Dermabond (Ethicon, Johnson & Johnson, New Jersey) is applied to an area of the capsule (measuring 3 × 3 cm) and to a sterile plastic ultrasound bag. The bag is then applied directly to the exposed capsule. BioGlue (Cyrolife Inc, Kennesaw, GA) is then injected into and around the bag/mass interface and allowed to solidify. A veress needle decompresses the cyst, and the ovary is delivered out of the peritoneal cavity for either cystectomy or an oophorectomy. Routine surveillance of the omentum, lymph nodes, contralateral ovary, and peritoneal surface is then performed. Results: Nine female patients (mean age, 14.1 ± 2 years) were treated. All had normal α-fetoprotein and human chorionic gonadotropin. Computed tomographic scans demonstrated cystic lesions ranging from 8.9 to 27 cm in diameter (17.1 ± 2.6 cm2). Operative procedures were: 4 salpingooophorectomies and 5 unilateral oophorectomies. In a single case, the contralateral ovary had a suspicious lesion, which was biopsied. No tumors spills occurred. The pathology included 2 simple cysts, 3 serous cyst adenomas, 3 mature cystic teratomas, and 1 immature teratoma with grade 2 to 3 immature elements. Peritoneal washings were negative. All patients were discharged within 48 hours and are well 15 months to 3.1 years postoperatively. Conclusions: The containment of the ovarian cyst with the application of surgical adhesives and a plastic sleeve offers a significant advancement in our ability to safely treat these lesions. This approach markedly reduces the length of the surgical incision while insuring the prevention of peritoneal contamination with cystic fluid.

Original languageEnglish
Pages (from-to)890-893
Number of pages4
JournalJournal of Pediatric Surgery
Volume42
Issue number5
DOIs
StatePublished - Jul 2007

Fingerprint

Teratoma
Cysts
Ovary
Ovariectomy
Plastics
Capsules
Neoplasms
Fetal Proteins
Ovarian Cysts
Omentum
Cystectomy
Operative Surgical Procedures
Peritoneal Cavity
Chorionic Gonadotropin
Adhesives
Adenoma
Needles
Lymph Nodes
Pathology

Keywords

  • Cancer
  • Minimally invasive surgery
  • Ovarian cyst

ASJC Scopus subject areas

  • Surgery

Cite this

Excision of large cystic ovarian tumors : combining minimal invasive surgery techniques and cancer surgery-the best of both worlds. / Ehrlich, Peter F.; Teitelbaum, Daniel H.; Hirschl, Ronald B.; Rescorla, Frederick.

In: Journal of Pediatric Surgery, Vol. 42, No. 5, 07.2007, p. 890-893.

Research output: Contribution to journalArticle

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AB - Background/Purpose: Cystic ovarian lesions can be massive, and preoperative evaluations can often not distinguish benign from malignant tumors. Up to 57% of malignant ovarian tumors have a cystic component. We present an approach to these neoplasms that adheres to oncologic principles using minimally invasive techniques. Methods: A 5-cm Pfannensteil incision is performed followed by peritoneal washings. The mass is identified and dried. Dermabond (Ethicon, Johnson & Johnson, New Jersey) is applied to an area of the capsule (measuring 3 × 3 cm) and to a sterile plastic ultrasound bag. The bag is then applied directly to the exposed capsule. BioGlue (Cyrolife Inc, Kennesaw, GA) is then injected into and around the bag/mass interface and allowed to solidify. A veress needle decompresses the cyst, and the ovary is delivered out of the peritoneal cavity for either cystectomy or an oophorectomy. Routine surveillance of the omentum, lymph nodes, contralateral ovary, and peritoneal surface is then performed. Results: Nine female patients (mean age, 14.1 ± 2 years) were treated. All had normal α-fetoprotein and human chorionic gonadotropin. Computed tomographic scans demonstrated cystic lesions ranging from 8.9 to 27 cm in diameter (17.1 ± 2.6 cm2). Operative procedures were: 4 salpingooophorectomies and 5 unilateral oophorectomies. In a single case, the contralateral ovary had a suspicious lesion, which was biopsied. No tumors spills occurred. The pathology included 2 simple cysts, 3 serous cyst adenomas, 3 mature cystic teratomas, and 1 immature teratoma with grade 2 to 3 immature elements. Peritoneal washings were negative. All patients were discharged within 48 hours and are well 15 months to 3.1 years postoperatively. Conclusions: The containment of the ovarian cyst with the application of surgical adhesives and a plastic sleeve offers a significant advancement in our ability to safely treat these lesions. This approach markedly reduces the length of the surgical incision while insuring the prevention of peritoneal contamination with cystic fluid.

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