OC16.06: The value of preoperative ultrasound in the selection of women with adnexal masses for laparoscopic surgery

To assess the value of preoperative ultrasound examination for predicting success of laparoscopic surgery in women with adnexal masses. Symptomatic women with clinical or ultrasound diagnosis of adnexal mass were offered a detailed transvaginal ultrasound scan in order to assess the feasibility of laparoscopic surgery. In all cases an attempt was made to establish a likely histological diagnosis using “pattern recognition” method. The selection criteria for laparoscopic surgery were: absence of any features suggestive of pelvic malignancy, no signs of severe pelvic endometriosis or adhesions and dermoid cysts < 10 cm in mean diameter. The laparoscopic surgery was classified as successful if the mass was removed completely without resorting to laparotomy. 145 women were diagnosed with a total of 164 adnexal cysts. 113 women (77.9%) were selected for laparoscopic surgery and the remaining 32 (22.1%) were offered laparotomy. On histological examination 162 (98.8%) cysts were benign and the remaining two cysts (1.2%) were borderline. Laparoscopic surgery was successful in 107/113 (94.7%) cases and in six women (5.3%) the operation was converted to laparotomy. The preoperative ultrasound assessment predicted the outcome of laparoscopic surgery with specificity of 0.84 (95% CI 0.67–0.93) and positive likelihood ratio of 6.33 (95% CI 3.0–13.2). A detailed preoperative ultrasound assessment is a helpful tool in estimating the feasibility of laparoscopic surgery in women with non-invasive adnexal lesions.