A novel surgical technique for the large ovarian cystic mass – combined mini-laparotomy and laparoscopy

Background: Laparoscopic resection of ovarian cysts > ten cm in diameter can be technically challenging. Laparotomy is often the preferred surgical approach. Minimal access surgery in gynaecology has been compared to laparotomy and has been shown to result in shorter patient hospital length of stay, reduced post-operative pain, and faster return to routine activities. Minimal access surgical techniques for ovarian masses > ten cm are therefore of interest as they may offer significant benefits. Objective: To assess the feasibility of a novel surgical technique using a combination of both laparoscopy and mini-laparotomy in the surgical management of ovarian cystic masses > ten cm. Outcomes including hospital length of stay, return to usual activities, post-operative complications, and patient satisfaction were assessed. Materials and Methods: A total of 17 patients who underwent surgery by a gynaecologic oncologist at a tertiary institution in Western Australia from June 2012 to September 2013 were selected. The risk of malignancy index was used to triage patients. A mini-laparotomy incision was utilised to downsize the mass and to retrieve the specimen, while the remainder of the procedure was performed by laparoscopy. Medical records were used to collect post-operative and follow up data. Patient satisfaction at six weeks post-surgery was analysed by means of a telephone questionnaire. Results: Patients had an average age of 52 years. They were more likely to be post-menopausal and to have a raised body mass index (BMI) (average BMI 29.6 kg/m² ). All 17 patients had an ovarian mass larger than ten cm in maximal diameter. Fourteen of the 17 cases were benign. Three patients were diagnosed with early stage mucinous ovarian tumours of low malignant potential. There were no malignancies. The procedure was associated with a high level of patient satisfaction. Conclusion: Combined mini-laparotomy and laparoscopy to resect ovarian masses > ten cm has potential benefits for patients in terms of faster recovery, lower analgesia requirements, and improved cosmetic outcome. Larger prospective studies are required to adequately assess complication rates, quality of life, and long-term outcomes in those patients with ovarian tumours of low malignant potential.

Ovarian cysts; Mini-laparotomy; Laparoscopy; Hand-assisted laparoscopy; Ovarian neoplasms.

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