Laparoscopic excision of adnexal masses.
OBJECTIVE
The purpose of the present study was to evaluate a prospective series of consecutive patients with adnexal masses selected with strict preoperative clinical and ultrasonographic criteria.


METHODS
Prospective series of consecutive patients (Canadian Task Force classification II-2).


METHODS
Tertiary care university hospitals.


METHODS
Six hundred and eighty-three consecutive patients under 40 years of age with ultrasonographic evidence of an adnexal cystic mass without thick septa, internal wall papillation, or solid components, except for sonographic pattern suggestive of dermoid.


METHODS
Operative laparoscopy and follow-up.


RESULTS
After initial diagnostic laparoscopy in 13 patients with stage 4 endometriosis and extensive bowel adhesions, in 2 patients with large-volume dermoids, and in 1 patient with suspect ovarian and peritoneal implants, the procedure was converted to laparotomy. Therefore, 667 patients were completely managed by laparoscopy. There were 1069 cysts excised. Histologic diagnosis was endometrioma in 57% of the excised cysts, serous cyst in 13%, dermoid in 12%, paratubal in 8%, mucinous cysts in 5.3%, functional cyst in 2.8%, other benign histotypes in 1.1%, and ovarian malignancies (seven borderline tumors and one endometrioma with a microfocus of G1 endometrioid carcinoma) in 0.7% of the cysts and 1.2% of the patients. These last patients are alive with no evidence of disease after a mean follow-up of 62 months.


CONCLUSIONS
In the present series, with accurate preoperative and intraoperative selection, the rate of unexpected borderline or focally invasive malignancies was 1.2% of the patients, and the laparoscopic management of these adnexal masses did not adversely impact on prognosis.
Marana
Riccardo
R
Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy.
Muzii
Ludovico
L
Catalano
Giovan Fiore
GF
Caruana
Paul
P
Oliva
Cosimo
C
Marana
Elisabetta
E
D000291:Adnexal Diseases / Q000175:diagnosis* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D001707:Biopsy, Needle; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D010149:Postoperative Pain; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome