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Article Dans Une Revue Journal of Minimally Invasive Gynecology Année : 2022

Protected Laparoscopic Large Ovarian Cyst Aspiration: A five steps alternative to laparotomy.

Résumé

Study objective: In this video, we describe a 5-step surgical technique that allows us to safely incise and aspirate the content of large ovarian cysts through a single-port laparoscopic incision. This allows performing laparoscopic oophorectomies instead of large xipho-pubic laparotomies. Design: A stepwise demonstration of the technique with narrated video footage. Setting: Ovarian masses, especially cysts, are common gynecologic conditions [1]. However, depending on their size, large adnexal cysts are usually managed with transverse or midline laparotomies [2]. This is to prevent cyst ruptures and abdominal contamination and ensure oncological safety of the procedure [3-5]. Different leak-proof aspiration techniques have been described in the literature allowing for safe large cyst aspiration and adnexectomy through a mini-laparotomy incision or via laparoscopy [2,3,6-10]. We describe a 5-step surgical technique allowing for closed aspiration of ovarian intracystic fluid and adnexectomy while respecting oncological safety. Interventions: Step 1: Perform diagnostic laparoscopy to rule out peritoneal carcinomatosis contraindicating this procedure and then after cyst exposition, thoroughly dry the cyst wall. Step 1 Bis: Cut the cuff of a sterile glove to prepare a square piece of membrane. Step 2: Place a protective gauze and then apply the surgical glue to the ovarian cyst wall followed by the glove/membrane application. Perform a purse suture through the glove/membrane and the ovarian wall superficially to ensure further adhesion and prevent ovarian fluid spillage. Step 3: Incise the ovarian wall, introduce the aspiration cannula and tighten the purse suture to aspirate the cystic fluid. Step 4: After aspiration is complete, tighten the suture and close the glove to guarantee a closed space and prevent abdominal contamination. Step 5: Perform laparoscopic oophorectomy or cystectomy. Safely remove the specimen in an endoscopic retrieval bag through the trocar incision. Conclusion: This technique allows safe laparoscopic large ovarian cysts resections while respecting oncologic safety and preventing intra-abdominal spillage and contamination.
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Dates et versions

hal-04415344 , version 1 (24-01-2024)

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Citer

H. El Hajj, Delphine Hudry, C. M. Gomez, A. Boscher, M. Duchatelet, et al.. Protected Laparoscopic Large Ovarian Cyst Aspiration: A five steps alternative to laparotomy.. Journal of Minimally Invasive Gynecology, 2022, Journal of Minimally Invasive Gynecology, ⟨10.1016/j.jmig.2022.06.018⟩. ⟨hal-04415344⟩

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