title: Excision of mature teratoma using culdotomy, with and without laparoscopy: a prospective randomised trial.
abstract: OBJECTIVE
  To compare the results of removing mature teratoma with laparoscopy or without laparoscopy.
  
  
  METHODS
  A prospective, randomised trial.
  
  
  METHODS
  Medical centre.
  
  
  METHODS
  Seventy-nine women with mature teratomas identified using results of ultrasound examinations and biochemical markers.
  
  
  METHODS
  Cystectomy with laparoscopic approach or without laparoscopic approach through a culdotomy.
  
  
  METHODS
  Patients were randomly assigned to have their cysts removed via vaginal cystectomy without laparoscopy (n = 37, Group A) or laparoscopic cystectomy via culdotomy opening (n = 42, Group B). Inclusion criteria were history of vaginal delivery, no previous abdominal surgery, no history of pelvic inflammatory disease, no medical illness, and no presenting symptoms. Eight women randomised to Group A withdrew before surgery. The laparoscopically resected tumours were each put into a cellulose bag, and tumours without laparoscopic-assistance were removed directly via the vagina.
  
  
  RESULTS
  Blood loss in Group A (88 +/- 37 ml) was significantly more than that in Group B (64 +/- 20 ml, P = 0.000). The post-operative recovery times were 20 and 17 hours, respectively (P = 0.030). The rates of successful surgery were 58.6 and 97.6%, respectively (P = 0.002). The spillage rates were 44.8% and 19.0%, respectively (P = 0.006). There were no significant differences in tumour size, patient age, and operative time between groups.
  
  
  CONCLUSIONS
  Cystectomy without assistance of laparoscopy could be applied to manage mature teratoma of the ovary; however, because of the difficulty of this technique, we had high percentages of tumour spillage and more blood loss during operation and a high percentage of patients who required conversion to laparotomy compared with laparoscopic cystectomy. We favoured laparoscopically assisted cystectomy to manage mature teratoma.
authors.affiliation: Department of Obstetrics and Gynecology, Veterans General Hospital-Taipei and Institute of Clinical Medicine, National Yang-Ming University, School of Medicine, Taiwan.
authors.forename: P H
authors.initials: PH
authors.lastname: Wang
authors.forename: W L
authors.initials: WL
authors.lastname: Lee
authors.forename: C M
authors.initials: CM
authors.lastname: Juang
authors.forename: W Y
authors.initials: WY
authors.lastname: Tsai
authors.forename: H T
authors.initials: HT
authors.lastname: Chao
authors.forename: C C
authors.initials: CC
authors.lastname: Yuan
mesh_terms: D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical; D001810:Blood Volume / Q000502:physiology; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000601:surgery*; D011446:Prospective Studies; D013724:Teratoma / Q000601:surgery*; D016896:Treatment Outcome