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

• Ki EY
• Park EK
• Jeong IC
• Bak SE
• Hwang HS
• Chung YH
• Song MJ

• KMID: 2457482
• DOI: http://doi.org/10.3349/ymj.2019.60.9.864

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.

Reference

1. Padilla LA, Radosevich DM, Milad MP. Accuracy of the pelvic examination in detecting adnexal masses. Obstet Gynecol. 2000; 96:593–598. PMID: 11004365.

2. Vizza E, Cutilloa G, Patrizi L, Saltari M, Baiocco E, Corrado G. Use of SAND balloon catheter for laparoscopic management of extremely large ovarian cysts. J Minim Invasive Gynecol. 2011; 18:779–784. PMID: 21802377.

3. Eltabbakh GH, Charboneau AM, Eltabbakh NG. Laparoscopic surgery for large benign ovarian cysts. Gynecol Oncol. 2008; 108:72–76. PMID: 17949797.

4. Ramirez PT, Furmovitz M, Wolf JK, Levenback C. Laparoscopic port-site metastases in patients with gynecological malignancies. Int J Gynecol Cancer. 2004; 14:1070–1077. PMID: 15571612.

5. Huang KG, Wang CJ, Chang TC, Liou JD, Hsueh S, Lai CH, et al. Management of port-site metastasis after laparoscopic surgery for ovarian cancer. Am J Obstet Gynecol. 2003; 189:16–21. PMID: 12861132.

6. Hopkins MP, von Gruenigen V, Gaich S. Laparoscopic port site implantation with ovarian cancer. Am J Obstet Gynecol. 2000; 182:735–736. PMID: 10739542.

7. Fader AN, Rojas-Espaillat L, Ibeanu O, Grumbine FC, Escobar PF. Laparoendoscopic single-site surgery (LESS) in gynecology: a multi-institutional evaluation. Am J Obstet Gynecol. 2010; 203:501. PMID: 20663487.

8. Takeda A, Imoto S, Mori M, Yamada J, Nakamura H. Management of large adnexal tumors by isobaric laparoendoscopic single-site surgery with a wound retractor. Eur J Obstet Gynecol Reprod Biol. 2013; 166:185–189. PMID: 23122034.

9. Vlahos NF, Iavazzo C, Marcopoulos MC, Alamanou A, Kouiroukidou P, Chatzidakis V, et al. Laparoscopic management of large ovarian cysts. Surg Innov. 2012; 19:370–374. PMID: 22371368.

10. Song T, Kim MK, Kim ML, Yoon BS, Seong SJ. Laparoendoscopic single-site surgery for extremely large ovarian cysts: a feasibility, safety, and patient satisfaction study. Gynecol Obstet Invest. 2014; 78:81–87. PMID: 24969078.

11. Yi SW. Minimally invasive management of huge ovarian cysts by laparoscopic extracorporeal approach. Minim Invasive Ther Allied Technol. 2012; 21:429–434. PMID: 22211916.

12. Kim WC, Im KS, Kwon YS. Single-port transumbilical laparoscopic-assisted adnexal surgery. JSLS. 2011; 15:222–227. PMID: 21902980.

13. Lee LC, Sheu BC, Chou LY, Huang SC, Chang DY, Chang WC. An easy new approach to the laparoscopic treatment of large adnexal cysts. Minim Invasive Ther Allied Technol. 2011; 20:150–154. PMID: 21082898.

14. Hong JH, Choi JS, Lee JH, Son CE, Jeon SW, Bae JW. Laparoscopic management of large ovarian tumors: clinical tips for overcoming common concerns. J Obstet Gynaecol Res. 2012; 38:9–15. PMID: 22070471.

15. Moulton LJ, Jernigan AM, Michener CM. Postoperative outcomes after single-port laparoscopic removal of adnexal masses in patients referred to gynecologic oncology at a large academic center. J Minim Invasive Gynecol. 2017; 24:1136–1144. PMID: 28673874.

16. Song MJ, Lee SJ, Yoo SH, Seo YH, Yoon JH. Single port gasless laparoscopy-assisted mini-laparotomic ovarian resection (SP-GLAMOR): reasonable treatment for large cystic ovarian tumors with suspicion of malignancy. Gynecol Oncol. 2014; 132:119–124. PMID: 24125748.

17. Sagiv R, Golan A, Glezerman M. Laparoscopic management of extremely large ovarian cysts. Obstet Gynecol. 2005; 105:1319–1322. PMID: 15932823.

18. Ba MC, Long H, Zhang XL, Gong YF, Yan ZF, Wang S, et al. Port-site metastases and chimney effect of B-ultrasound-guided and laparoscopically-assisted hyperthermic intraperitoneal perfusion chemotherapy. Yonsei Med J. 2017; 58:497–504. PMID: 28332353.