Small-bore Single Laparoscopy-assisted Trans-vaginal Ovarian Cystectomy for Benign Ovarian Diseases

Aims: To evaluate the feasibility of small-bore single laparoscopy-assisted trans-vaginal ovarian cystectomy.
Study Designs: A retrospective study was performed through a review of the medical records of women who had undergone laparoscopy-assisted trans-vaginal ovarian cystectomy for benign conditions.
Place and Duration of Study: Department of obstetrics & gynecology of Her women’s clinic and Chonnam National University Hospital, Between January 2010 to January 2014.
Methodology: 148 women had undergone small-bore (3-5mm) single-port laparoscopy-assisted trans-vaginal ovarian cystectomy for benign adnexal mass. The technique consists of small bore single laparoscopic inspection phase, trans-vaginal operative phase, and laparoscopic checking phase. Age, parity, body mass index (BMI), bilaterality, dimensions of mass, location, total operative time, hemoglobin change, and complications were measured.
Results: 148 procedures were successfully completed without the need for extra-umbilical puncture. The mean±SD of total operative time and the largest dimension of the mass were 46.9±21.5min and 6.9±4.1cm, respectively. Spillage of cystic contents was minimal, and if it did occur, it was localized to the posterior cul-de-sac with no related complication. The median decline in the hemoglobin level from before surgery to postoperative day 1 was 1.7±0.8g/dL. The pathologic diagnoses were as follows: dermoid cyst, 82; endometriotic cyst, 31; corpus luteal cyst, 12; serous cystadenoma, 5; mucinous cystadenoma, 9; parovarian or paratubal cyst, 9.
The postoperative courses were uneventful in most patients, but four had a transient fever greater than 38ºC and 8 women had small operation site hematoma. All of them recovered following conservative management.
Conclusion: We believe that small-bore single laparoscopy-assisted trans-vaginal ovarian cystectomy ensures the advantages of trans-vaginal surgery and the safety of the laparoscope.