Laparoscopic management of large endometrial cysts: Surgical procedure, Indications and limitations

Object: Abdominal laparotomy is often performed to treat large ovarian endometrial cysts. We determined the safety and feasibility of performing laparoscopic resection for large endometrial ovarian cysts.Design: A retrospective cohort study. Methods: Between June 2005 and August 2013, we performed laparoscopic surgery in 534 patients with endometrial ovarian cysts at the Yotsuya Medical Cube Women's Center. Patients with ovarian endometrial cysts were divided into the large-cysts ( ≥ 10 cm) and normal-size cysts ( < 10 cm) groups. In cases of large ovarian endometriosis with severe adhesion, we performed laparoscopic-assisted ovarian cystectomy (LAC) using double balloon catheters, which combined intra- and extra-abdominal procedures with small incisions instead of a large open laparotomy. We compared the rates of operative complication, operative time, amount of bleeding, and pathological findings between the two groups.Results: We performed laparoscopic surgery in 45 patients with large ovarian cysts. More patients had high serum CA-125 scores and r-ASRM scores in the large-cysts group than in the normal-size cysts group. Patients in the large-cysts group had severe endometriosis, and we performed the LAC procedure in 14 patients of this group. The average operative time and amount of bleeding were increased in the large-cysts group compared with the normal-size cysts group. However, there were no differences in the operative complications between the groups.Conclusion: We performed laparoscopic cystectomy in 45 cases of large severe endometrial cysts without complications. These results suggest that laparoscopic management of large endometrial ovarian cysts is safe and feasible.