A new approach to ovarian cystectomy: a combined laparoscopic and extra-abdominal microsurgical technique.

Our objective was to apply a new surgical technique to ovarian cystectomy combining the advantages of laparoscopy with the benefits of microsurgical principles, in an attempt to simplify the surgical laparoscopic procedure and reduce postoperative adhesion formation. Between May 1991 and March 1992, extracorporal ovarian cystectomy was performed in 27 patients who presented with persistent ovarian cysts at the department of gynecology of a large teaching hospital that receives primary referrals from public health care patients. Patients were referred with the diagnosis of a persistent ovarian cyst. Diagnosis was confirmed by pelvic bimanual examination, and transvaginal ultrasound. Cases where malignancy was suspected due to the presence of ascites, semi-solid or solid masses, demonstration of papillations within the ovarian cyst on ultrasound, or elevated CA-125 levels (unless endometriosis was suspected) were excluded from the study group. At laparoscopy, after inspection of the abdominal cavity the cyst was aspirated. The ovary was then extracted through a 2- to 3-cm lower-abdominal incision, cystectomy was meticulously performed according to microsurgical principles, and the repaired ovary was then returned into the abdominal cavity. Extracorporal cystectomy was successfully performed in 26 of 27 cases. The mean duration of the operative procedure was 55 min. The postoperative course was uneventful. Mean postoperative hospitalization time was 22.4 h. Over a follow-up period of up to 15 months, ovarian folliculogenesis was confirmed ultrasonographically. In the first 2 patients to undergo second-look laparoscopy, no adhesions were seen.(ABSTRACT TRUNCATED AT 250 WORDS)