Single-Port Laparoscopic Surgery versus Laparotomy for the Treatment of Large Ovarian Cysts during Pregnancy: A Retrospective Comparative Study

Single-Port Laparoscopic Surgery versus Laparotomy for the Treatment of Large Ovarian Cysts during Pregnancy: A Retrospective Comparative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Single-Port Laparoscopic Surgery versus Laparotomy for the Treatment of Large Ovarian Cysts during Pregnancy: A Retrospective Comparative Study Haibin Zhang, Lihui Li, Huiyan Wang, Chunna Wei, Zhen Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8180398/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Feb, 2026 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted 37 You are reading this latest preprint version Abstract Objective To investigate the safety and feasibility of single-port access laparoscopic surgery for the treatment of large ovarian tumors during pregnancy. Methods In total, 12 patients who underwent Single port access laparoscopic surgery(group 2) for large Ovarian tumors between January 2021 and July 2022 were compared to control group comprising 16 laparotomy treatment(group1) that were performed during the same period. We retrospectively analyzed multiple clinical characteristics and operative outcomes of all the patients, including age, body mass index, size and pathological type of Ovarian tumors, operative time, estimated blood loss (EBL), duration of postoperative hospital stay, etc. Results No statistically significant differences were observed between the two groups in terms of preoperative baseline characteristics. The mean (SD) cyst diameter in Group 1 was 12.44 (6.13) cm, while in Group 2, it was 10.58 (1.83) cm. Comparable surgical outcomes were achieved in both groups. However, operative time was significantly shorter in Group 2 compared to Group 1, at 95.31 (17.82) minutes versus 56.00 (15.06) minutes (p < 0.05). Blood loss was significantly lower in Group 2 compared to Group 1, at 12.08 (6.20) mL versus 33.13 (19.57) mL (p < 0.05). Additionally, the mean hospital stay was shorter in Group 2 compared to Group 1, at 7.88 (0.96) days versus 4.00 (0.95) days (p < 0.05). Conclusion Our results suggest that Single port access laparoscopic surgery for large Ovarian tumors during pregnancy may be a safe and feasible alternative to laparotomy treatment. Laparoendoscopic single-site surgery Laparoscopic assisted surgery Minimally invasive surgery Ovary Single port Figures Figure 1 Introduction The incidences of ovarian tumors are reported as 0.17% to 5.9% in asymptomatic women and 7.1% to 12% in symptomatic women[ 1 ]. Ovarian tumors first diagnosed during pregnancy often present a challenge for both the obstetrician and gynecologists providing pregnancy care and for the consulting subspecialists. The reported incidence ovarian tumors during pregnancy varies from as high as 1:630 to as low as 1:2020 and is not only dependent on the population being studied but is also greatly influenced by the frequency of routine prenatal ultrasound (US) examinations in that population[ 2 , 3 ]. Most ovarian tumors are benign, incidental findings of pregnancy which resolve spontaneously. They may present clinically due to haemorrhage, rupture, torsion and mass effect. Laparoscopic surgery could be considered a gold standard for management of ovarian tumors[ 4 ]. The contraindication for laparoscopic management is not clearly established concerning the size of ovarian tumors. Some suggest that proper management for ovarian tumors larger than 8 to 10 cm in size is laparotomy[ 5 , 6 ]. Recently, several studies have reported the surgical outcomes of Single port access laparoscopic surgery for the management of ovarian tumors[ 7 – 10 ], however these reports usually excluded large ovarian cyst who was pregnancy. The present study was designed to evaluate the feasibility and safety of Single port access laparoscopic surgery for treatment of large ovarian cysts who was pregnancy and to compare surgical outcomes, morbidity with laparotomy. Methods Between January 2021 and July 2022, 16 pregnant patients underwent laparotomy treatment of large ovarian cysts (group 1) at the Shijiazhuang Obstetrics and Gynecology Hospital. Surgical outcomes, complications, and spillage rates were compared retrospectively with 12 case-matched pregnant patients who underwent Single port access laparoscopic group (group 2). The Institutional Review Board of our hospital approved the study. All patients underwent a physical examination, routine laboratory tests, and pelvic ultrasound. When malignancy was suspected, further evaluation such as abdominal and pelvic magnetic resonance image, were performed. Furthermore, routine preoperative workup was performed in every patients (patient’s abdominal operation history, preoperative laboratory studies including tumor marker such as CA 125, complete blood count, routine chemistry, electrolyte, prothrombin time/adjusted partial prothrombin time, chest radiography, electrocardiography). Eligibility criteria included no evidence of malignancy on imaging studies, major diameter of the cyst larger than 5 cm on preoperative imaging studies, easy mobility on physical examination, and appropriate medical status for laparoscopic surgery. Gestational age < 24 weeks. Exclusion criteria included the presence of an obviously malignant tumor on imaging studies, high serum CA-125 levels (<500 U/mL), and suspicion of severe pelvic adhesions at physical examination. Signs of threatened abortion.History of abdominal surgery. Surgical technique All operations were performed by physicians undergoing training under the supervision of an experienced surgeon. The procedures were performed with the patient under general anesthesia with endotracheal intubation, according to a standard anesthetic regimen. The decision, for oophorectomy or ovarian cystectomy depended on the clinical situation. Single-port assisted extracorporeal cystectomy was conducted using an OctoPort (HangTian, KaDi, China), which is composed of 2 parts, a 30-mm wound retractor and a detachable port cap with 5 access ports (two 12-mm ports and three 5-mm port) (Fig. 1AB). Under endotracheal general anesthesia, patients were placed in a dorsolithotomy position. A 2.5-cm vertical skin incision was made at the umbilicus, subcutaneous fat tissue was dissected, and the peritoneum was opened. The OctoPort wound retractor was then introduced into the peritoneal cavity (Fig. 1CD), and the port cap was fixed to the wound retractor. Pneumoperitoneum was maintained at 12 mmHg.Then inserted through the 12-mm port to examine the ovarian cyst, contralateral ovary, peritoneal surface, and omentum. The detachable port cap was then removed, the ovarian cyst wall was pulled out from the umbilical incision and placed in the incision protector (Fig. 1 E). A needle-shaped suction device was used to puncture the cyst, and the clear cystic fluid was slowly aspirated. The ovarian cyst wall was then bluntly and sharply dissected from the incision site, and the ovary was sutured continuously with absorbable 2 − 0 suture.The ovary was then placed in the peritoneal cavity, the detachable cap was reinserted, and pneumoperitoneum was reestablished for final inspection.The abdominal cavity gas was evacuated, and the laparoscope, instruments, and incision protector were removed. The skin incision was sutured, and the surgery was completed. Operating time was definedas the time of first surgical incision to the time of last stitch. Operative blood loss was assessed by measuring all aspirated blood, weighing the swabs, and estimating the amount of blood on drapes. Febrile morbidity was defined as temperature > 38°C on two occasions 24 hours apart.Parameters analyzed included age, body mass index, largest cyst diameter, operative time, blood loss, length of hospital stay and complications. Statistical analysis Statistical analysis was performed using commercially available software (SPSS version 25.0; IBM SPSS). Surgical procedure, operative (OR) time, estimated blood loss (EBL), perioperative complications, and length of stay (LOS) were collected in a database.Differences between subsets were evaluated using the Student t test, and differences between proportions were compared using the χ2 test and the Fisher exact test. A p value <05 was considered statistically signifificant. Results A total of 28 patients were enrolled in the study.Tables 1 show respectively the patient demographics and surgical outcomes. The average age, body mass index of the patients in group 1 were 28.19 years and 23.59 kg/m2 ,in group 2 were 28.17 years and 24.91 kg/m2 respectively .There was no signifificant statistical difference insofar as age and body mass index between the 2 groups. Ovarian cysts in group 1 included 3 mature cystic teratomas (18%), 9 mucinous cystadenomas (56%), 2 serous cystadenoma (13%), and 2 endometrioma (13%); in group 2 included 4 mature cystic teratomas (33%), 5 mucinous cystadenomas (42%), 2 serous cystadenomas (17%and 1 endometrioma (8%)(Table 1 ). Table 1 Patients and tumor characteristics Patients and tumor characteristcs Variable Group1(n = 16) Group2(n = 12) p value Age,yr 28.19 ± 3.75 28.17 ± 3.43 0.98 Body mass index 23.59 ± 2.99 24.91 ± 5.43 0.419 Gestational weeks 16.63(6.19) 15.83(4.57) Histologic type Mature cystic teratoma 3(18) 4(33) Mucinous cystadenoma 9(56) 5(42) Serous cystadenoma 2(13) 2(17) Endometrioma 2(13) 1(8) Largest diameter,cm 12.44(6.13) 10.58(1.83) Emergency operation 6(37.50) 4(33.33) Comparison of surgical observation indexes between the two groups The largest mean (SD) cyst diameter in group 1 was 12.44 (6.13) cm, in group 2 was 10.58 (1.83) cm(Table 1 ). Operative time was significantly shorter in group 2 than in group 1, at 95.31 (17.82) minutes vs 56.00 (15.06) minutes (p<0.05). Blood loss was signifificantly lower in group 2 than in groups 1, at 12.08 (6.20) mL vs 33.13 (19.57) mL (p<0.05). Mean hospital stay was shorter in group 2 than in group 1, at 7.88 (0.96) days vs 4.00 (0.95) days (p<0.05)(Table 2 ). Table 2 Comparison of surgical observation indexes between the two groups Surgical outcomes,complications Variable Group1(n = 16) Group2(n = 12) p value Operative time,min 95.31 ± 17.82 56 ± 15.06 0.00 Blood loss,ml 33.13 ± 19.57 12.08 ± 6.20 0.01 Hospital stay,days 7.88 ± 0.96 4.00 ± 0.95 0.00 postoperative anal exhaust time 17.17 ± 5.12 39.44 ± 15.13 0.00 Complications Fever 3 1 Wound disruption 0 0 Urinary tract infection 0 0 Clostridium difficile colitis 0 0 Postoperative exhaust time 39.44 ± 15.13 17.17 ± 5.12 0.02 Comparison of postoperative observation indexes between the two groups No intraoperative complications that required treatment occurred in any group. Insofar as postoperative complications, 3 patients in group 1 had fever; and 1 patients in group 2 had fever.Comparison of postoperative anal exhaust time in group 2 was signifificantly shorter than in group 1, at 17.17(5.12) vs 39.44(15.13) p<0.05(Table 2 ).No postoperative incisional hernia occurred in both groups.Conversion to laparotomy was not necessary in the laparoscopic groups, and no additional trocars were needed in Single port access laparoscopic surgery group. Comparison of follow-up pregnancy outcomes between the two groups In group 1, there were 13 patients had partus maturus, 2 patients had preterm births, and 1 patient had miscarriage; in group 2, 11 patients had partus maturus and 1 patient had preterm births.There was no significant difference in pregnancy outcome and delivery gestational week between the two groups (P > 0.05), and no neonatal asphyxia occurred between the two groups(Table 3 ). Table 3 Comparison of follow-up pregnancy outcomes between the two groups Pregnancy outcome Variable Group 1 (n = 16) Group 2 (n = 12 ) Partus maturus 13 11 Premature delivery 2 1 Abortion 1 0 Induced labour 0 0 Delivery mode Vaginal delivery 4 10 Caesarean section 11 2 Neonatal outcome Gestational week of delivery Neonatal asphyxia 0 0 Discussion In the first trimester of pregnancy, ovarian cysts are often functional and generally resolve without complications. After 16 weeks’ gestation the prevalence of ovarian cysts is reported to be between 0.5% and 3.0%[ 11 ]. Fagotti el. reported that the prevalence of ovarian cysts beyond 16 weeks’ gestation was 0.9%[ 12 ]. In a previous cross-sectional study of some 2245 women scanned at the end of the first trimester, 1.2% of the total number of cysts detected persisted beyond 16 weeks and subsequently were surgically removed; there were no cases of malignancy[ 1 ]. In our study, the mean gestational age was 16.63 weeks in the open group and 15.83 weeks in the single well group, which is consistent with previous studies. In a study of 55278 women undergoing termination of pregnancy, there were two cases of ovarian malignancy[ 2 ]. Expectant management of ovarian masses is advocated, at least until the pregnancy is beyond 14 weeks’ gestation. When they are symptomatic, simple ovarian cysts diagnosed during pregnancy can be successfully and safely treated with ultrasound-guided cyst aspiration[ 11 ]. Ovarian torsion is a very important diagnosis to consider because it warrants urgent intervention. The presence of an ovarian mass markedly increases the risk of ovarian torsion[ 13 ]. Of all cases of ovarian torsion, approximately 10–20% occur in pregnancy[ 13 ] most commonly in the first and early second trimesters[ 14 ]. The overall risk of ovarian torsion in pregnancy is about 0.1%[ 14 ] [ 15 ], but the risk increases up to 5–15% in the presence of an ovarian mass[ 15 ]. The symptoms of torsion in pregnancy are similar to those of non-pregnant women[ 16 ]. Examination findings are often more pronounced in cases of torsion compared to rupture[ 17 ]. The patient is more likely to be tachycardic, tachypnoeic and have low oxygen saturations. Pregnant women with torsion do not appear to display peritoneal signs as often as their non-pregnant counterparts[ 18 ]. In our study, a total of 10 patients (35.71%) underwent emergency surgical treatment, of which 4 underwent single-hole surgery and 6 underwent open surgery, all of which were ovarian torsion. Laparoscopic cystectomy for treatment of a large ovarian cyst presents several technical problems. the laparoscopic approach is technically hindered by the limited working space available, risk of inadvertent rupture during Veress needle or trocar insertion, and difficulties associated with surgical specimen removal. In a recent study, only cyst size and cystectomy demonstrated a positive and significant association with inadvertent cyst rupture[ 19 ]. Furthermore, ovarian cysts>5cm in greatest diameter are associated with a higher risk of malignancy[ 20 ]. To overcome the limitations of conventional laparoscopy associated with large ovarian cysts, We introduced the single-hole technology. According to this method, after aspiration of cystic contents, the cyst is pulled out though the umbilicus and extracorporeal cystectomy is then performed. Therefore, inspection of the entire peritoneal cavity and meticulous irrigation are necessary at laparoscopy. The ease of change between extracorporeal and laparoscopic procedures is important for improving surgical outcomes. In our practice, we use a specialized multichannel single port to facilitate the transition between extracorporeal and laparoscopic procedures.Previous studies have demonstrated novel surgical techniques[ 21 , 22 ]. However, to our knowledge, no previous study has compared the single-port assisted extracorporeal approach with conventional laparoscopy and laparotomy. To the best of our knowledge, this is the first report of Ovarian cysts during pregnancy treated with Single port access laparoscopic. In the literature, several types of surgery were conducted to manage Ovarian cysts, such as laparoscopy versus laparotomy, or radical surgery versus fertilitypreserving surgery. Single-site laparoscopic ovarian cystectomy can be very challenging in pregnancy, especially when the need for suturing arises. Since the utero-ovarian ligament tissues are usually overstretched during pregnancy as the uterus enlarges, selected adnexal masses could be exteriorized. Exteriorizing the ovary and cyst after intraperitoneal drainage may allow for extracorporeal suturing that is faster and easier. Kim and Kwon[ 23 ] first reported LESS for exteriorization and cystectomy of an ovarian tumor in week 12 of the pregnancy. As for postoperative management, the routine use of prophylactic tocolytics is under discussion. In a study evaluating the safety and feasibility of gasless LESS in the management of adnexal masses during pregnancy[ 24 ], three intramuscular doses (5 mg/body, 8h apart) of isoxsuprine hydrochloride were routinely administered as prophylactic tocolysis for 3 days in the postoperative period.Yin et al. studied six pregnant women with ovarian cysts and only one patient used tocolytics postoperatively because of signs of uterine contraction[ 25 ]. Xiao et al. claimed that tocolytics are not required postoperatively for prophylaxis in those who are not experiencing uterine contractions based on their experience[ 26 ]. According to SAGES guidelines, there is no evidence to support the routine use of prophylactic tocolytics. In our case series, tocolytic drugs were not routinely used prophylactically only one patient used tocolytics postoperatively in the Single port access laparoscopic group and 3 patient in the laparotomy because of signs of uterine contraction. According to SAGES guidelines for the use of laparoscopy during pregnancy, laparoscopy can be safely performed during any trimester of pregnancy when an operation is indicated. In the literature review, the GA at surgery ranged from 4 to 31 + 4 weeks.As for the first trimester, Lee et al. retrospectively reviewed the medical records of 14 women with intrauterine pregnancies who underwent LESS for the treatment of an adnexal mass[ 27 ]. Eleven patients were in the first trimester at surgery, and abortion occurred in one case 2 weeks after the operation. In another study reported by Jiang et al.,10 pregnant patients underwent LESS for gynecological acute abdomen in their first trimester[ 28 ]. One patient who underwent LESS salpingectomy reported vaginal bleeding at 1 week following surgery and then experienced a spontaneous abortion at 11 weeks GA. In our case series,Only 1 patient had preterm birth in the Single port access laparoscopic group, 1 patient had miscarriage in the laparotomy group and 1 patient had intrauterine fetal death. As for postoperative management, the routine use of prophylactic tocolytics is under discussion. In a study evaluating the safety and feasibility of gasless LESS in the management of adnexal masses during pregnancy (21), three intramuscular doses (5 mg/body, 8 h apart) of isoxsuprine hydrochloride were routinely administered as prophylactic tocolysis for 3 days in the postoperative period. Xiao et al. (22) claimed that tocolytics are not required postoperatively for prophylaxis in those who are not experiencing uterine contractions based on their experience. According to SAGES guidelines, there is no evidence to support the routine use of prophylactic tocolytics. However, these drugs may be indicated when signs of preterm labor are present. In our case series, tocolytic drugs were not routinely used prophylactically and only one patient used tocolytics postoperatively because of signs of uterine contraction. Here, we presented our initial experience of single-port laparoscopic adnexal surgery and assessed the safety and feasibility of the procedures.However, our study also has weaknesses, namely, its retrospective nature and limited sample size. Additionally, bias caused by a single-center analysis may also have influenced the findings of the study. In conclusion , single-port assisted extracorporeal cystectomy provides an alternative procedure for management of large ovarian cysts during pregnancy. This technique provides superior surgical outcomes that are comparable with those of laparotomy treatment for pregnancied women with large ovarian cysts, with no increase in perioperative complications and no recurrence after surgery. Declarations Ethics approval and consent to participate This study was conducted in accordance with the ethical principles of the World Medical Association's Declaration of Helsinki. The study protocol was reviewed and approved by the Ethics Committee of Shijiazhuang Obstetrics and Gynecology Hospital. Due to the retrospective nature of the study, the requirement for informed consent was waived by the ethics committee. Consent for publication This study has been reviewed and approved by the Institutional Review Board of the Shijiazhuang Obstetrics and Gynecology Hospital. The manuscript is an original work and has not been submitted or is under consideration for publication in another journal. The study complies with current ethical consideration. We also confirm that all the listed authors have participated actively in the study, and have seen and approved the submitted manuscript. Competing interests Not applicable. This manuscript does not contain any individual person's data. Funding This work was supported by the Shijiazhuang Health Bureau (Grant number 20251121). The funding body played no role in the design of the study, collection, analysis, interpretation of data, or in writing the manuscript. Author Contribution H.Z. and L.L. contributed equally to this work. H.Z. and L.L. contributed to the study conception and design. Data collection and analysis were performed by H.W., C.W. and Z.Z. The first draft of the manuscript was written by H.Z. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Acknowledgements Not applicable. Data Availability The datasets generated and analyzed during the current study are not publicly available due to patient privacy concerns but are available from the corresponding author on reasonable request. References Padilla LA, Radosevich DM, Milad MP. Accuracy of the pelvic examination in detecting adnexal masses. Obstet Gynecol. 2000;96(4):593–8. Whitecar P, Turner S, Higby K. Adnexal masses in pregnancy: A review of 130 cases undergoing surgical management. 1999. 181(1): pp. 19–24. Schmeler KM, et al. Adnexal masses in pregnancy: surgery compared with observation. Obstet Gynecol. 2005;105(5 Pt 1):1098–103. Canis M, et al. Laparoscopic management of adnexal masses: a gold standard? Curr Opin Obstet Gynecol. 2002;14(4):423–8. Chapron C, et al. Laparoscopic management of organic ovarian cysts: is there a place for frozen section diagnosis? Hum Reprod. 1998;13(2):324–9. Maiman M, Seltzer V, Boyce J. Laparoscopic excision of ovarian neoplasms subsequently found to be malignant. Obstet Gynecol. 1991;77(4):563–5. Kim TJ, et al. Single port access laparoscopic adnexal surgery. J Minim Invasive Gynecol. 2009;16(5):612–5. Lee YY, et al. Single port access laparoscopic adnexal surgery versus conventional laparoscopic adnexal surgery: a comparison of peri-operative outcomes. Eur J Obstet Gynecol Reprod Biol. 2010;151(2):181–4. Kim WC, Im KS, Kwon YS. Single-port transumbilical laparoscopic-assisted adnexal surgery. Jsls. 2011;15(2):222–7. Kim WC, et al. Laparoendoscopic single-site surgery (LESS) for adnexal tumors: one surgeon's initial experience over a one-year period. Eur J Obstet Gynecol Reprod Biol. 2011;158(2):265–8. Senarath S, Ades A, Nanayakkara P. Ovarian cysts in pregnancy: a narrative review. J Obstet Gynaecol. 2021;41(2):169–75. Fagotti A, et al. Perioperative outcomes of laparoendoscopic single-site surgery (LESS) versus conventional laparoscopy for adnexal disease: a case–control study. Surg Innov. 2011;18(1):29–33. Hakoun AM, et al. Adnexal masses in pregnancy: An updated review. Avicenna J Med. 2017;7(4):153–7. Ginath S, et al. Differences between adnexal torsion in pregnant and nonpregnant women. J Minim Invasive Gynecol. 2012;19(6):708–14. Condous G, et al. Should we be examining the ovaries in pregnancy? Prevalence and natural history of adnexal pathology detected at first-trimester sonography. Ultrasound Obstet Gynecol. 2004;24(1):62–6. Naqvi M, Kaimal A. Adnexal masses in pregnancy. Clin Obstet Gynecol. 2015;58(1):93–101. Bottomley C, Bourne T. Diagnosis and management of ovarian cyst accidents. Best Pract Res Clin Obstet Gynaecol. 2009;23(5):711–24. Hasson J, et al. Comparison of adnexal torsion between pregnant and nonpregnant women. Am J Obstet Gynecol. 2010;202(6):e5361–6. Smorgick N, et al. Laparoscopic removal of adnexal cysts: is it possible to decrease inadvertent intraoperative rupture rate? Am J Obstet Gynecol. 2009;200(3):e2371–3. Sassone AM, et al. Transvaginal sonographic characterization of ovarian disease: evaluation of a new scoring system to predict ovarian malignancy. Obstet Gynecol. 1991;78(1):70–6. Goh SM, et al. Minimal access approach to the management of large ovarian cysts. Surg Endosc. 2007;21(1):80–3. Lee LC, et al. An easy new approach to the laparoscopic treatment of large adnexal cysts. Minim Invasive Ther Allied Technol. 2011;20(3):150–4. Kim WC, Kwon YS. Laparoendoscopic single-site surgery for exteriorization and cystectomy of an ovarian tumor during pregnancy. J Minim Invasive Gynecol. 2010;17(3):386–9. Takeda A, Imoto S, Nakamura H. Gasless laparoendoscopic single-site surgery for management of adnexal masses during pregnancy. Eur J Obstet Gynecol Reprod Biol. 2014;180:28–34. Yin M, et al. Laparoendoscopic single-site surgery for adnexal disease during pregnancy: A single-center preliminary experience. Front Surg. 2022;9:994360. Xiao J, et al. Pregnancy-preserving Laparoendoscopic Single-site Surgery for Gynecologic Disease: A Case Series. J Minim Invasive Gynecol. 2020;27(7):1588–97. Lee JH, et al. Safety and feasibility of a single-port laparoscopic adnexal surgery during pregnancy. J Minim Invasive Gynecol. 2013;20(6):864–70. Jiang D, et al. Laparoendoscopic single-site compared with conventional laparoscopic surgery for gynaecological acute abdomen in pregnant women. J Int Med Res. 2021;49(10):3000605211053985. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 24 Feb, 2026 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted Editorial decision: Revision requested 30 Dec, 2025 Reviews received at journal 28 Dec, 2025 Reviews received at journal 28 Dec, 2025 Reviews received at journal 27 Dec, 2025 Reviewers agreed at journal 27 Dec, 2025 Reviews received at journal 27 Dec, 2025 Reviews received at journal 26 Dec, 2025 Reviewers agreed at journal 26 Dec, 2025 Reviewers agreed at journal 24 Dec, 2025 Reviews received at journal 23 Dec, 2025 Reviews received at journal 23 Dec, 2025 Reviews received at journal 23 Dec, 2025 Reviewers agreed at journal 22 Dec, 2025 Reviewers agreed at journal 22 Dec, 2025 Reviews received at journal 21 Dec, 2025 Reviewers agreed at journal 21 Dec, 2025 Reviewers agreed at journal 21 Dec, 2025 Reviewers agreed at journal 21 Dec, 2025 Reviews received at journal 20 Dec, 2025 Reviewers agreed at journal 20 Dec, 2025 Reviewers agreed at journal 19 Dec, 2025 Reviews received at journal 19 Dec, 2025 Reviewers agreed at journal 19 Dec, 2025 Reviewers agreed at journal 19 Dec, 2025 Reviews received at journal 19 Dec, 2025 Reviews received at journal 19 Dec, 2025 Reviewers agreed at journal 19 Dec, 2025 Reviewers agreed at journal 19 Dec, 2025 Reviews received at journal 19 Dec, 2025 Reviewers agreed at journal 19 Dec, 2025 Reviewers agreed at journal 19 Dec, 2025 Reviewers agreed at journal 19 Dec, 2025 Reviewers invited by journal 19 Dec, 2025 Editor assigned by journal 19 Dec, 2025 Editor invited by journal 09 Dec, 2025 Submission checks completed at journal 09 Dec, 2025 First submitted to journal 27 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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00:17:38","extension":"html","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":77842,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8180398/v1/94e5673b14b7585eea90fe9b.html"},{"id":99188239,"identity":"a2e73b20-45d6-4eaf-a636-4ca95d135b99","added_by":"auto","created_at":"2025-12-30 00:17:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":2247027,"visible":true,"origin":"","legend":"\u003cp\u003e(A)Wound retractor .(B) port cap.Inserting the SPLS port through a 2-3 cm trasverse transumbilcal incision(C).The SPLS part has two 12-mm port and three 5-mm ports.Aspiration of cystic contents and cyst pilled out to the extracorporeal space(E).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8180398/v1/18224038a49564e149ee659e.png"},{"id":103765547,"identity":"ed4a926d-8156-44b8-96c6-339cc023706c","added_by":"auto","created_at":"2026-03-02 16:03:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4061783,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8180398/v1/80239c22-b094-4661-890d-a85b681c33d2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Single-Port Laparoscopic Surgery versus Laparotomy for the Treatment of Large Ovarian Cysts during Pregnancy: A Retrospective Comparative Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe incidences of ovarian tumors are reported as 0.17% to 5.9% in asymptomatic women and 7.1% to 12% in symptomatic women[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Ovarian tumors first diagnosed during pregnancy often present a challenge for both the obstetrician and gynecologists providing pregnancy care and for the consulting subspecialists. The reported incidence ovarian tumors during pregnancy varies from as high as 1:630 to as low as 1:2020 and is not only dependent on the population being studied but is also greatly influenced by the frequency of routine prenatal ultrasound (US) examinations in that population[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Most ovarian tumors are benign, incidental findings of pregnancy which resolve spontaneously. They may present clinically due to haemorrhage, rupture, torsion and mass effect. Laparoscopic surgery could be considered a gold standard for management of ovarian tumors[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The contraindication for laparoscopic management is not clearly established concerning the size of ovarian tumors. Some suggest that proper management for ovarian tumors larger than 8 to 10 cm in size is laparotomy[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Recently, several studies have reported the surgical outcomes of Single port access laparoscopic surgery for the management of ovarian tumors[\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], however these reports usually excluded large ovarian cyst who was pregnancy.\u003c/p\u003e \u003cp\u003eThe present study was designed to evaluate the feasibility and safety of Single port access laparoscopic surgery for treatment of large ovarian cysts who was pregnancy and to compare surgical outcomes, morbidity with laparotomy.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eBetween January 2021 and July 2022, 16 pregnant patients underwent laparotomy treatment of large ovarian cysts (group 1) at the Shijiazhuang Obstetrics and Gynecology Hospital. Surgical outcomes, complications, and spillage rates were compared retrospectively with 12 case-matched pregnant patients who underwent Single port access laparoscopic group (group 2). The Institutional Review Board of our hospital approved the study.\u003c/p\u003e \u003cp\u003eAll patients underwent a physical examination, routine laboratory tests, and pelvic ultrasound. When malignancy was suspected, further evaluation such as abdominal and pelvic magnetic resonance image, were performed. Furthermore, routine preoperative workup was performed in every patients (patient\u0026rsquo;s abdominal operation history, preoperative laboratory studies including tumor marker such as CA 125, complete blood count, routine chemistry, electrolyte, prothrombin time/adjusted partial prothrombin time, chest radiography, electrocardiography).\u003c/p\u003e \u003cp\u003eEligibility criteria included no evidence of malignancy on imaging studies, major diameter of the cyst larger than 5 cm on preoperative imaging studies, easy mobility on physical examination, and appropriate medical status for laparoscopic surgery. Gestational age\u0026thinsp;\u0026lt;\u0026thinsp;24 weeks.\u003c/p\u003e \u003cp\u003eExclusion criteria included the presence of an obviously malignant tumor on imaging studies, high serum CA-125 levels (\u0026lt;500 U/mL), and suspicion of severe pelvic adhesions at physical examination. Signs of threatened abortion.History of abdominal surgery.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSurgical technique\u003c/h2\u003e \u003cp\u003eAll operations were performed by physicians undergoing training under the supervision of an experienced surgeon. The procedures were performed with the patient under general anesthesia with endotracheal intubation, according to a standard anesthetic regimen. The decision, for oophorectomy or ovarian cystectomy depended on the clinical situation.\u003c/p\u003e \u003cp\u003eSingle-port assisted extracorporeal cystectomy was conducted using an OctoPort (HangTian, KaDi, China), which is composed of 2 parts, a 30-mm wound retractor and a detachable port cap with 5 access ports (two 12-mm ports and three 5-mm port) (Fig.\u0026nbsp;1AB). Under endotracheal general anesthesia, patients were placed in a dorsolithotomy position. A 2.5-cm vertical skin incision was made at the umbilicus, subcutaneous fat tissue was dissected, and the peritoneum was opened. The OctoPort wound retractor was then introduced into the peritoneal cavity (Fig.\u0026nbsp;1CD), and the port cap was fixed to the wound retractor. Pneumoperitoneum was maintained at 12 mmHg.Then inserted through the 12-mm port to examine the ovarian cyst, contralateral ovary, peritoneal surface, and omentum. The detachable port cap was then removed, the ovarian cyst wall was pulled out from the umbilical incision and placed in the incision protector (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eE). A needle-shaped suction device was used to puncture the cyst, and the clear cystic fluid was slowly aspirated. The ovarian cyst wall was then bluntly and sharply dissected from the incision site, and the ovary was sutured continuously with absorbable 2\u0026thinsp;\u0026minus;\u0026thinsp;0 suture.The ovary was then placed in the peritoneal cavity, the detachable cap was reinserted, and pneumoperitoneum was reestablished for final inspection.The abdominal cavity gas was evacuated, and the laparoscope, instruments, and incision protector were removed. The skin incision was sutured, and the surgery was completed.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eOperating time was definedas the time of first surgical incision to the time of last stitch. Operative blood loss was assessed by measuring all aspirated blood, weighing the swabs, and estimating the amount of blood on drapes. Febrile morbidity was defined as temperature\u0026thinsp;\u0026gt;\u0026thinsp;38\u0026deg;C on two occasions 24 hours apart.Parameters analyzed included age, body mass index, largest cyst diameter, operative time, blood loss, length of hospital stay and complications.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using commercially available software (SPSS version 25.0; IBM SPSS). Surgical procedure, operative (OR) time, estimated blood loss (EBL), perioperative complications, and length of stay (LOS) were collected in a database.Differences between subsets were evaluated using the Student t test, and differences between proportions were compared using the χ2 test and the Fisher exact test. A p value \u0026lt;05 was considered statistically signifificant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 28 patients were enrolled in the study.Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e show respectively the patient demographics and surgical outcomes. The average age, body mass index of the patients in group 1 were 28.19 years and 23.59 kg/m2 ,in group 2 were 28.17 years and 24.91 kg/m2 respectively .There was no signifificant statistical difference insofar as age and body mass index between the 2 groups. Ovarian cysts in group 1 included 3 mature cystic teratomas (18%), 9 mucinous cystadenomas (56%), 2 serous cystadenoma (13%), and 2 endometrioma (13%); in group 2 included 4 mature cystic teratomas (33%), 5 mucinous cystadenomas (42%), 2 serous cystadenomas (17%and 1 endometrioma (8%)(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatients and tumor characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003ePatients and tumor characteristcs\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup1(n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup2(n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge,yr\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.19\u0026thinsp;\u0026plusmn;\u0026thinsp;3.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.17\u0026thinsp;\u0026plusmn;\u0026thinsp;3.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.59\u0026thinsp;\u0026plusmn;\u0026thinsp;2.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.91\u0026thinsp;\u0026plusmn;\u0026thinsp;5.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.419\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.63(6.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.83(4.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eHistologic type\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMature cystic teratoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMucinous cystadenoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerous cystadenoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndometrioma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLargest diameter,cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.44(6.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.58(1.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(37.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(33.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eComparison of surgical observation indexes between the two groups\u003c/h3\u003e\n\u003cp\u003eThe largest mean (SD) cyst diameter in group 1 was 12.44 (6.13) cm, in group 2 was 10.58 (1.83) cm(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Operative time was significantly shorter in group 2 than in group 1, at 95.31 (17.82) minutes vs 56.00 (15.06) minutes (p\u0026lt;0.05). Blood loss was signifificantly lower in group 2 than in groups 1, at 12.08 (6.20) mL vs 33.13 (19.57) mL (p\u0026lt;0.05). Mean hospital stay was shorter in group 2 than in group 1, at 7.88 (0.96) days vs 4.00 (0.95) days (p\u0026lt;0.05)(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of surgical observation indexes between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eSurgical outcomes,complications\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup1(n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup2(n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperative time,min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95.31\u0026thinsp;\u0026plusmn;\u0026thinsp;17.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u0026thinsp;\u0026plusmn;\u0026thinsp;15.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood loss,ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.13\u0026thinsp;\u0026plusmn;\u0026thinsp;19.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.08\u0026thinsp;\u0026plusmn;\u0026thinsp;6.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital stay,days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epostoperative anal exhaust time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.17\u0026thinsp;\u0026plusmn;\u0026thinsp;5.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.44\u0026thinsp;\u0026plusmn;\u0026thinsp;15.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWound disruption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrinary tract infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClostridium difficile colitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative exhaust time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39.44\u0026thinsp;\u0026plusmn;\u0026thinsp;15.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.17\u0026thinsp;\u0026plusmn;\u0026thinsp;5.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eComparison of postoperative observation indexes between the two groups\u003c/h3\u003e\n\u003cp\u003eNo intraoperative complications that required treatment occurred in any group. Insofar as postoperative complications, 3 patients in group 1 had fever; and 1 patients in group 2 had fever.Comparison of postoperative anal exhaust time in group 2 was signifificantly shorter than in group 1, at 17.17(5.12) vs 39.44(15.13) p\u0026lt;0.05(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).No postoperative incisional hernia occurred in both groups.Conversion to laparotomy was not necessary in the laparoscopic groups, and no additional trocars were needed in Single port access laparoscopic surgery group.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eComparison of follow-up pregnancy outcomes between the two groups\u003c/h2\u003e \u003cp\u003eIn group 1, there were 13 patients had partus maturus, 2 patients had preterm births, and 1 patient had miscarriage; in group 2, 11 patients had partus maturus and 1 patient had preterm births.There was no significant difference in pregnancy outcome and delivery gestational week between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), and no neonatal asphyxia occurred between the two groups(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of follow-up pregnancy outcomes between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003ePregnancy outcome\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup 1 (n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup 2 (n\u0026thinsp;=\u0026thinsp;12 )\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePartus maturus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePremature delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbortion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInduced labour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eDelivery mode\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaginal delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCaesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eNeonatal outcome\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational week of delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeonatal asphyxia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the first trimester of pregnancy, ovarian cysts are often functional and generally resolve without complications. After 16 weeks\u0026rsquo; gestation the prevalence of ovarian cysts is reported to be between 0.5% and 3.0%[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Fagotti el. reported that the prevalence of ovarian cysts beyond 16 weeks\u0026rsquo; gestation was 0.9%[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In a previous cross-sectional study of some 2245 women scanned at the end of the first trimester, 1.2% of the total number of cysts detected persisted beyond 16 weeks and subsequently were surgically removed; there were no cases of malignancy[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In our study, the mean gestational age was 16.63 weeks in the open group and 15.83 weeks in the single well group, which is consistent with previous studies.\u003c/p\u003e \u003cp\u003eIn a study of 55278 women undergoing termination of pregnancy, there were two cases of ovarian malignancy[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Expectant management of ovarian masses is advocated, at least until the pregnancy is beyond 14 weeks\u0026rsquo; gestation. When they are symptomatic, simple ovarian cysts diagnosed during pregnancy can be successfully and safely treated with ultrasound-guided cyst aspiration[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOvarian torsion is a very important diagnosis to consider because it warrants urgent intervention. The presence of an ovarian mass markedly increases the risk of ovarian torsion[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Of all cases of ovarian torsion, approximately 10\u0026ndash;20% occur in pregnancy[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] most commonly in the first and early second trimesters[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The overall risk of ovarian torsion in pregnancy is about 0.1%[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], but the risk increases up to 5\u0026ndash;15% in the presence of an ovarian mass[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The symptoms of torsion in pregnancy are similar to those of non-pregnant women[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Examination findings are often more pronounced in cases of torsion compared to rupture[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The patient is more likely to be tachycardic, tachypnoeic and have low oxygen saturations. Pregnant women with torsion do not appear to display peritoneal signs as often as their non-pregnant counterparts[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In our study, a total of 10 patients (35.71%) underwent emergency surgical treatment, of which 4 underwent single-hole surgery and 6 underwent open surgery, all of which were ovarian torsion.\u003c/p\u003e \u003cp\u003eLaparoscopic cystectomy for treatment of a large ovarian cyst presents several technical problems. the laparoscopic approach is technically hindered by the limited working space available, risk of inadvertent rupture during Veress needle or trocar insertion, and difficulties associated with surgical specimen removal. In a recent study, only cyst size and cystectomy demonstrated a positive and significant association with inadvertent cyst rupture[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Furthermore, ovarian cysts\u0026gt;5cm in greatest diameter are associated with a higher risk of malignancy[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. To overcome the limitations of conventional laparoscopy associated with large ovarian cysts, We introduced the single-hole technology. According to this method, after aspiration of cystic contents, the cyst is pulled out though the umbilicus and extracorporeal cystectomy is then performed. Therefore, inspection of the entire peritoneal cavity and meticulous irrigation are necessary at laparoscopy. The ease of change between extracorporeal and laparoscopic procedures is important for improving surgical outcomes. In our practice, we use a specialized multichannel single port to facilitate the transition between extracorporeal and laparoscopic procedures.Previous studies have demonstrated novel surgical techniques[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, to our knowledge, no previous study has compared the single-port assisted extracorporeal approach with conventional laparoscopy and laparotomy.\u003c/p\u003e \u003cp\u003eTo the best of our knowledge, this is the first report of Ovarian cysts during pregnancy treated with Single port access laparoscopic. In the literature, several types of surgery were conducted to manage Ovarian cysts, such as laparoscopy versus laparotomy, or radical surgery versus fertilitypreserving surgery. Single-site laparoscopic ovarian cystectomy can be very challenging in pregnancy, especially when the need for suturing arises. Since the utero-ovarian ligament tissues are usually overstretched during pregnancy as the uterus enlarges, selected adnexal masses could be exteriorized. Exteriorizing the ovary and cyst after intraperitoneal drainage may allow for extracorporeal suturing that is faster and easier. Kim and Kwon[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] first reported LESS for exteriorization and cystectomy of an ovarian tumor in week 12 of the pregnancy.\u003c/p\u003e \u003cp\u003eAs for postoperative management, the routine use of prophylactic tocolytics is under discussion. In a study evaluating the safety and feasibility of gasless LESS in the management of adnexal masses during pregnancy[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], three intramuscular doses (5 mg/body, 8h apart) of isoxsuprine hydrochloride were routinely administered as prophylactic tocolysis for 3 days in the postoperative period.Yin et al. studied six pregnant women with ovarian cysts and only one patient used tocolytics postoperatively because of signs of uterine contraction[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Xiao et al. claimed that tocolytics are not required postoperatively for prophylaxis in those who are not experiencing uterine contractions based on their experience[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. According to SAGES guidelines, there is no evidence to support the routine use of prophylactic tocolytics. In our case series, tocolytic drugs were not routinely used prophylactically only one patient used tocolytics postoperatively in the Single port access laparoscopic group and 3 patient in the laparotomy because of signs of uterine contraction.\u003c/p\u003e \u003cp\u003e According to SAGES guidelines for the use of laparoscopy during pregnancy, laparoscopy can be safely performed during any trimester of pregnancy when an operation is indicated. In the literature review, the GA at surgery ranged from 4 to 31\u003csup\u003e+\u0026thinsp;4\u003c/sup\u003e weeks.As for the first trimester, Lee et al. retrospectively reviewed the medical records of 14 women with intrauterine pregnancies who underwent LESS for the treatment of an adnexal mass[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Eleven patients were in the first trimester at surgery, and abortion occurred in one case 2 weeks after the operation. In another study reported by Jiang et al.,10 pregnant patients underwent LESS for gynecological acute abdomen in their first trimester[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. One patient who underwent LESS salpingectomy reported vaginal bleeding at 1 week following surgery and then experienced a spontaneous abortion at 11 weeks GA. In our case series,Only 1 patient had preterm birth in the Single port access laparoscopic group, 1 patient had miscarriage in the laparotomy group and 1 patient had intrauterine fetal death.\u003c/p\u003e \u003cp\u003eAs for postoperative management, the routine use of prophylactic tocolytics is under discussion. In a study evaluating the safety and feasibility of gasless LESS in the management of adnexal masses during pregnancy (21), three intramuscular doses (5 mg/body, 8 h apart) of isoxsuprine hydrochloride were routinely administered as prophylactic tocolysis for 3 days in the postoperative period. Xiao et al. (22) claimed that tocolytics are not required postoperatively for prophylaxis in those who are not experiencing uterine contractions based on their experience. According to SAGES guidelines, there is no evidence to support the routine use of prophylactic tocolytics. However, these drugs may be indicated when signs of preterm labor are present. In our case series, tocolytic drugs were not routinely used prophylactically and only one patient used tocolytics postoperatively because of signs of uterine contraction.\u003c/p\u003e \u003cp\u003eHere, we presented our initial experience of single-port laparoscopic adnexal surgery and assessed the safety and feasibility of the procedures.However, our study also has weaknesses, namely, its retrospective nature and limited sample size. Additionally, bias caused by a single-center analysis may also have influenced the findings of the study.\u003c/p\u003e \u003cp\u003e \u003cb\u003eIn conclusion\u003c/b\u003e, single-port assisted extracorporeal cystectomy provides an alternative procedure for management of large ovarian cysts during pregnancy. This technique provides superior surgical outcomes that are comparable with those of laparotomy treatment for pregnancied women with large ovarian cysts, with no increase in perioperative complications and no recurrence after surgery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003e This study was conducted in accordance with the ethical principles of the World Medical Association's Declaration of Helsinki. The study protocol was reviewed and approved by the Ethics Committee of Shijiazhuang Obstetrics and Gynecology Hospital. Due to the retrospective nature of the study, the requirement for informed consent was waived by the ethics committee.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003e This study has been reviewed and approved by the Institutional Review Board of the Shijiazhuang Obstetrics and Gynecology Hospital. The manuscript is an original work and has not been submitted or is under consideration for publication in another journal. The study complies with current ethical consideration. We also confirm that all the listed authors have participated actively in the study, and have seen and approved the submitted manuscript.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eNot applicable. This manuscript does not contain any individual person's data.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis work was supported by the Shijiazhuang Health Bureau (Grant number 20251121). The funding body played no role in the design of the study, collection, analysis, interpretation of data, or in writing the manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eH.Z. and L.L. contributed equally to this work. H.Z. and L.L. contributed to the study conception and design. Data collection and analysis were performed by H.W., C.W. and Z.Z. The first draft of the manuscript was written by H.Z. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available due to patient privacy concerns but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePadilla LA, Radosevich DM, Milad MP. Accuracy of the pelvic examination in detecting adnexal masses. Obstet Gynecol. 2000;96(4):593\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhitecar P, Turner S, Higby K. Adnexal masses in pregnancy: A review of 130 cases undergoing surgical management. 1999. 181(1): pp. 19\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchmeler KM, et al. Adnexal masses in pregnancy: surgery compared with observation. Obstet Gynecol. 2005;105(5 Pt 1):1098\u0026ndash;103.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCanis M, et al. Laparoscopic management of adnexal masses: a gold standard? Curr Opin Obstet Gynecol. 2002;14(4):423\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChapron C, et al. Laparoscopic management of organic ovarian cysts: is there a place for frozen section diagnosis? Hum Reprod. 1998;13(2):324\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaiman M, Seltzer V, Boyce J. Laparoscopic excision of ovarian neoplasms subsequently found to be malignant. Obstet Gynecol. 1991;77(4):563\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim TJ, et al. Single port access laparoscopic adnexal surgery. J Minim Invasive Gynecol. 2009;16(5):612\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee YY, et al. Single port access laparoscopic adnexal surgery versus conventional laparoscopic adnexal surgery: a comparison of peri-operative outcomes. Eur J Obstet Gynecol Reprod Biol. 2010;151(2):181\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim WC, Im KS, Kwon YS. Single-port transumbilical laparoscopic-assisted adnexal surgery. Jsls. 2011;15(2):222\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim WC, et al. Laparoendoscopic single-site surgery (LESS) for adnexal tumors: one surgeon's initial experience over a one-year period. Eur J Obstet Gynecol Reprod Biol. 2011;158(2):265\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSenarath S, Ades A, Nanayakkara P. Ovarian cysts in pregnancy: a narrative review. J Obstet Gynaecol. 2021;41(2):169\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFagotti A, et al. Perioperative outcomes of laparoendoscopic single-site surgery (LESS) versus conventional laparoscopy for adnexal disease: a case\u0026ndash;control study. Surg Innov. 2011;18(1):29\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHakoun AM, et al. Adnexal masses in pregnancy: An updated review. Avicenna J Med. 2017;7(4):153\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGinath S, et al. Differences between adnexal torsion in pregnant and nonpregnant women. J Minim Invasive Gynecol. 2012;19(6):708\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCondous G, et al. Should we be examining the ovaries in pregnancy? Prevalence and natural history of adnexal pathology detected at first-trimester sonography. Ultrasound Obstet Gynecol. 2004;24(1):62\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaqvi M, Kaimal A. Adnexal masses in pregnancy. Clin Obstet Gynecol. 2015;58(1):93\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBottomley C, Bourne T. Diagnosis and management of ovarian cyst accidents. Best Pract Res Clin Obstet Gynaecol. 2009;23(5):711\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHasson J, et al. Comparison of adnexal torsion between pregnant and nonpregnant women. Am J Obstet Gynecol. 2010;202(6):e5361\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmorgick N, et al. Laparoscopic removal of adnexal cysts: is it possible to decrease inadvertent intraoperative rupture rate? Am J Obstet Gynecol. 2009;200(3):e2371\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSassone AM, et al. Transvaginal sonographic characterization of ovarian disease: evaluation of a new scoring system to predict ovarian malignancy. Obstet Gynecol. 1991;78(1):70\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoh SM, et al. Minimal access approach to the management of large ovarian cysts. Surg Endosc. 2007;21(1):80\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee LC, et al. An easy new approach to the laparoscopic treatment of large adnexal cysts. Minim Invasive Ther Allied Technol. 2011;20(3):150\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim WC, Kwon YS. Laparoendoscopic single-site surgery for exteriorization and cystectomy of an ovarian tumor during pregnancy. J Minim Invasive Gynecol. 2010;17(3):386\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTakeda A, Imoto S, Nakamura H. Gasless laparoendoscopic single-site surgery for management of adnexal masses during pregnancy. Eur J Obstet Gynecol Reprod Biol. 2014;180:28\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYin M, et al. Laparoendoscopic single-site surgery for adnexal disease during pregnancy: A single-center preliminary experience. Front Surg. 2022;9:994360.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXiao J, et al. Pregnancy-preserving Laparoendoscopic Single-site Surgery for Gynecologic Disease: A Case Series. J Minim Invasive Gynecol. 2020;27(7):1588\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee JH, et al. Safety and feasibility of a single-port laparoscopic adnexal surgery during pregnancy. J Minim Invasive Gynecol. 2013;20(6):864\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang D, et al. Laparoendoscopic single-site compared with conventional laparoscopic surgery for gynaecological acute abdomen in pregnant women. J Int Med Res. 2021;49(10):3000605211053985.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Laparoendoscopic single-site surgery, Laparoscopic assisted surgery, Minimally invasive surgery, Ovary, Single port","lastPublishedDoi":"10.21203/rs.3.rs-8180398/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8180398/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo investigate the safety and feasibility of single-port access laparoscopic surgery for the treatment of large ovarian tumors during pregnancy.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn total, 12 patients who underwent Single port access laparoscopic surgery(group 2) for large Ovarian tumors between January 2021 and July 2022 were compared to control group comprising 16 laparotomy treatment(group1) that were performed during the same period. We retrospectively analyzed multiple clinical characteristics and operative outcomes of all the patients, including age, body mass index, size and pathological type of Ovarian tumors, operative time, estimated blood loss (EBL), duration of postoperative hospital stay, etc.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eNo statistically significant differences were observed between the two groups in terms of preoperative baseline characteristics. The mean (SD) cyst diameter in Group 1 was 12.44 (6.13) cm, while in Group 2, it was 10.58 (1.83) cm. Comparable surgical outcomes were achieved in both groups. However, operative time was significantly shorter in Group 2 compared to Group 1, at 95.31 (17.82) minutes versus 56.00 (15.06) minutes (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Blood loss was significantly lower in Group 2 compared to Group 1, at 12.08 (6.20) mL versus 33.13 (19.57) mL (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, the mean hospital stay was shorter in Group 2 compared to Group 1, at 7.88 (0.96) days versus 4.00 (0.95) days (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eOur results suggest that Single port access laparoscopic surgery for large Ovarian tumors during pregnancy may be a safe and feasible alternative to laparotomy treatment.\u003c/p\u003e","manuscriptTitle":"Single-Port Laparoscopic Surgery versus Laparotomy for the Treatment of Large Ovarian Cysts during Pregnancy: A Retrospective Comparative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-30 00:17:33","doi":"10.21203/rs.3.rs-8180398/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision 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