Management of adnexal masses by operative laparoscopy. Selection criteria.

The management of adnexal masses by operative laparoscopy is controversial. The application of strict criteria for preoperative patient selection and careful intraoperative assessment and management are critical to the appropriate use of this approach. Clinical examination, ultrasound imaging of the pelvis and the addition of the CA-125 tumor marker in postmenopausal women can aid in the selection of a population at low risk for malignancy that may be appropriate for operative laparoscopic adnexal surgery. Recommended procedures include careful intraoperative inspection of the pelvis and abdomen, liberal use of frozen sections, and conversion to immediate-staging laparotomy when malignancy is found.