Laparoscopic management of ovarian dermoid cysts

Objective: To evaluate the safety and potential advantages of laparoscopic approach for management of ovarian dermoid cysts.
Design: Retrospective study.
Methods: From May 1999 to February 2002, 28 patients underwent laparoscopic removal of dermoid cysts.
Intervention: Exposure of Douglass pouch and avoidance of Trenedelenberg's position offered guarantee that any spilled material will be collected and confined to Cul de sac only with no further spread. After removal of cyst, we perform forceful jet wash lavage and aspiration simultaneously using wide bored 2 canulae from both lateral ports using copious amount of fluid (8-12 liters)
Results: Thirty-one dermoid cysts with mean diameter of 7.5 centimeter were removed successfully in 28 patients. The operative techniques employed were ovarian cystectomy for 28 cysts, salpingo-oophrectomy for 3 cysts and one case had salpingo-oophrectomy together with LAVH. In one case we performed concomitant hysteroscopic excision of complete uterine septum. Fourteen cysts were removed through enucleation and removal through trocar sleeve. Ten cases were treated via enucleation and removal within impermeable endobag. Seven cases were managed by removal of cysts via posterior colpotomy; one of them was associated during step of LAVH. We encountered total of fourteen spillages during the procedures. Spillage occured in 10 cases (71%) in instance of trocar removal without the use of endo bag, one case (10%) for removal within impermeable endo bag, and 3 cases (42%) in cases of colpotomy removal. No spillage occurred in the case of LAVH. Mean hospital stay after surgery was 0.9 day, and there were no significant intraoperative complications apart from inferior epigastric injury at site of secondary puncture.
Conclusion: After we did review of 14 studies in the literature added to our study, we revealed only 0.2% incidence of chemical peritonitis following laparoscopic removal of dermoid cysts. Laparoscopic approach allows proper exposure of Cul de sac and allows forceful jet lavage aspiration ensuring pelvic clean out from any microscopic material of the dermoid cyst. A situation may not be available during open laparotomy.