Adnexal masses: techniques, principles
Epublication WebSurg.com, Mar 2012;12(03). URL: http://websurg.com/doi/lt03envanherendael001
When dealing with adnexal masses, it is fundamental to learn how to diagnose them, to exclude functional cysts, and to address benign and malignant conditions properly. Looking back on past history, the main factor is the patient’s age, considering that the risk of malignancy increases significantly after menopause. An appropriate selection of patients has helped in the reduction of occurrence of unexpected cancer managed by laparoscopy to 4-6/1000 women with adnexal masses. The operator should always follow surgical principles which include careful examination of the external surface of the tumor, peritoneal cytology, prevention of cyst rupture, prevention of contact between the cyst and the abdominal wall and frozen section examination in case of suspicious lesion. The dermoid cyst is the most common type of ovarian germ cell tumor and the recommended treatment is cystectomy following conventional principles: ovarian capsule incision, cyst wall dissection (making sure not to open it), selective coagulation of bleeders and ovarian closure according to the case. In the case of endometriotic cysts it is recommended to preserve as much ovarian tissue as possible and to preserve the vascularization in the ovarian hilus. Finally during cyst removal from the abdominal cavity, the use of plastic bags has been associated with the lowest rate of cyst spillage.