Transumbilical single-site laparoscopy takes the advantage of ultraminilaparotomy in managing an extremely large ovarian cyst

The purpose of this article is to describe a new minimally invasive technique for an extremely large ovarian tumor. From July 2010 to June 2011, three patients with large pelvic cystic tumor which extended up to or beyond the level of the umbilicus were recruited. All these patients were managed through a transumbilical 2-cm ultraminilaparotomy protected by the Alexis wound retractor and then combined with a single-port laparoscopy, which was accessed through three 5-mm cannulas fixed on the glove fingers. In ultraminilaparotomy mode and protection of spillage the tumor fluid was sucked out, and then the collapsed ovarian tumor was exteriorized for enucleation and repair. Finally the laparoscopic mode resumed for check-up and complete surveillance of the whole abdominal cavity. The procedures were completed uneventfully in all three patients, with a small amount of blood loss and shortened operation time. We found this approach offers the advantages of attentive prevention of tumor spillage and wound contamination over traditional laparoscopy, and a better cosmetic outcome and more comprehensive ability to manage the associated pathologies outside the reach of pure ultraminilaparotomy. This application not only provides both advantages of ultraminilaparotomy and laparoscopy but it also overcomes the limitations of both approaches. Therefore, it is the surgical approach of choice for a patient bearing an extremely large ovarian cystic tumor.