ABSTRACT

Our aims are to present patient data in the laparoscopic management of mature cystic teratomas; 22 cases of mature cystic teratoma were managed laparoscopically, 15 cases of mature cystic teratomas were managed by laparoscopic cystectomy, and 7 patients with mature cystic teratomas were managed by laparoscopic oophorectomy.

Review of cases of women with mature cystic teratoma who underwent laparoscopic surgery in our clinic from 2008 to 2014. The medical records were searched for age, presenting symptoms, investigations, operative reports, postoperative hospital stay, and complications. Surgery was performed using a laparoscopic approach with a 10-mm port placed in the umbilicus through which a 10 mm 0-degree telescope was used. Two 10-mm and 5-mm working ports were used in the right and left iliac fossae. Initially, the whole peritoneal cavity was inspected as a whole to confirm the diagnosis, exclude malignancy, and inspect the contra-lateral ovary. If the ovary was twisted, it was untwisted, and after stabilizing the ovary, a superficial incision was made with diathermy on the anti-mesenteric border. The incision was gently enlarged to separate the cyst from the surrounding ovarian tissue. Hemostasis was achieved, and the cyst was retrieved through an endo-bag through the 10 mm port site.

Twenty-two cases of mature cystic teratoma were managed between 2008 and 2014 in our clinic. The age ranged from 19 to 40 years (average 28.2 years), and there were 22 pathology cases of mature cystic teratoma. All patients had a normal tumor marker. Fifteen women underwent laparoscopic cystectomy, and 7 women underwent laparoscopic oophorectomy. Spillage of cyst contents into the peritoneal cavity was occured in 8 patients (36%). Postoperative complications occurred in 1 patient. No malignancy was reported in the postoperative period.

Laparoscopic surgery should be chosen for women with mature cystic teratoma. The laparoscopic approach offers fewer postoperative adhesions, reduced pain, shorter hospital stay, and better cosmetic results. In order to avoid peritonitis, cyst contents can usually be adequately removed by using a careful technique and peritoneal lavage. To minimize spillage of the cyst’s contents and subsequent complications, the surgeon should choose the technique that is more effective and less traumatic to the patient. Conservative therapy by laparoscopy is recommended to preserve ovarian function in young patients. When it occurs, chemical peritonitis following dermoid spillage can be a very serious complication. If spillage occurs, complete removal of cyst contents and copious lavage should be performed to avoid peritonitis. Although peritonitis following rupture of a dermoid cyst is very rare, being aware of this complication is the key to diagnosis and appropriate management. (JAREM 2014; 2: 55-7)