Abstract
Objective: Our purpose was to compare the laparoscopic surgical techniques for ovarian dermoid cysts and to determine the safety and efficacy of laparoscopic ovarian cystectomy.
Design: We conducted a retrospective study of 100 patients who underwent laparoscopic cystectomy for ovarian dermoid cyst at Gifu Municipal Hospital from April 2008 to September 2010. Based on surgical approach, we divided the laparoscopic cystectomy into 2 surgical methods: the laparoscopy-assisted cystectomy (LAC) and the total laparoscopic cystectomy (TLC). Cases of TLC were further divided into 2 groups, those with or without cyst aspiration.
Results: Forty-seven cases, including larger cyst (≥80 mm diameter), complicated pregnancy, and bilateral or polycystic tumors, were safely treated by LAC without leakage of the cyst contents. Among cases managed by TLC without cyst aspiration (non-puncture group, n=32), cyst contents leaked during cystectomy in 14 cases (43.8%). TLC cases with cyst aspiration (puncture group, n=21) were operated more safely compared to the non-puncture group, and the leakage of cyst contents occurred in 8 cases (38.0%). In all TLC cases, there were significant differences (p<0.05) in the probability of leakage during operation between cysts ≥60mm and those <60mm (non-puncture group 100% vs. 33.3% puncture group; 70.0% vs. 9.1% overall). Chemical peritonitis did not occur in any of the cases reviewed.
Conclusion: To prevent the leakage of cyst contents, LAC surgery might be a better option for more difficult cases, including those with cysts ≥60mm in diameter. In TLC surgery for cysts <60 mm, although the puncture method tends to be superior to non-puncture method with regard to preventing leakage, we should select the best procedure according to the conditions of each case.
