Laparoscopic management of adnexal masses: a gold standard?
OBJECTIVE
To review recent literature on the laparoscopic management of adnexal masses, when this approach may be considered as a gold standard.


RESULTS
Cyst rupture was recently demonstrated to be a significant prognostic factor in stage I invasive epithelial carcinoma, and it was recommended to restrict the laparoscopic approach to patients with preoperative evidence that the cyst was benign. The laparoscopic approach is still highly controversial in masses suspicious at ultrasound. The limits of the laparoscopic approach are discussed reviewing recent literature and our experience. The laparoscopic management of adnexal masses appears to be safe in most hospitals even in developing countries. This approach is being used with increasing frequency in unusual indications such as newborns, children, adolescents and pregnant women. The learning curve for endoscopic surgery appears to be longer than expected. Many patients with benign adnexal masses, such as ovarian endometrioma, are still treated by laparotomy or with an inadequate endoscopic technique. Several studies have suggested that the stripping technique is a tissue-sparing procedure.


CONCLUSIONS
The laparoscopic puncture of malignant ovarian tumours confined to the ovaries is uncommon, and should be avoided whenever possible. The teaching of endoscopy is essential to promote adequate procedures performed according to the principles of microsurgery and to preserve postoperative ovarian physiology.
Canis
Michel
M
Department of Obstetrics, Gynecology and Reproductive Medicine, CHU Polyclinique, Boulevard Léon Malfreyt, 63033 Clermont-Ferrand, France. mcanis@chu-clermontferrand.fr
Rabischong
Benoit
B
Houlle
Celine
C
Botchorishvili
Revaz
R
Jardon
Kris
K
Safi
Antoine
A
Wattiez
Arnaud
A
Mage
Gérard
G
Pouly
Jean Luc
JL
Bruhat
Maurice Antoine
MA
D000291:Adnexal Diseases / Q000601:surgery; D002983:Clinical Competence; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000193:education / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D009366:Neoplasm Seeding; D010048:Ovarian Cysts / Q000601:surgery; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery; D011677:Punctures / Q000009:adverse effects; D012307:Risk Factors; D012422:Rupture, Spontaneous / Q000150:complications / Q000209:etiology