Laparoscopic Surgery for Large Benign Ovarian Cysts

In previous studies of laparoscopic surgery for women with ovarian cysts, most patients had small cysts. The present prospective study evaluated the laparoscopic approach in 33 consecutive women operated on during a 7-year period for ovarian cysts having a maximum diameter of 10 cm or more. All had laboratory and radiological features suggesting benign disease. Participants ranged in age from 17 to 73 years, averaging 45 years. The mean body mass index was 30, with a range of 21 to 42. Prospective patients whose maximum cyst diameter exceeded 30 cm were excluded from the study. Laparoscopic surgery proved effective in all but 2 instances, for a success rate of 94%. Two patients with adhesions were converted to laparotomy. No surgical or postoperative complications were recorded. Operating time averaged 82 minutes, and estimated blood loss, 89 mL. The hospital stay averaged just under 1 day; more than two-thirds of patients were discharged on the day of surgery. The procedures most frequently performed were unilateral salpingo-oophorectomy (SO) and laparoscopically assisted vaginal hysterectomy with bilateral SO. Cysts were extracted by aspiration through the vagina in 11 cases, by a lower quadrant incision in 5, and via an umbilical incision in 15. The most common pathologic finding was serous cystadenoma, followed by mucinous cystadenoma, dermoid, endometriosis, benign epithelial-lined cyst, and—in 2 cases—borderline ovarian tumor. All 4 women who were pregnant at the time of laparoscopic surgery, from 14 to 18 estimated weeks of gestational age, had a good outcome. These findings support accumulating evidence that laparoscopic surgery is an effective and safe procedure for removing large benign ovarian cysts.