title: A minimally invasive technique for management of the large adnexal mass.
abstract: OBJECTIVE
  To describe our experience managing large pelvic masses through a minilaparotomy incision using a flexible, self-retaining wound retractor and exteriorized drainage by application of 2-octyl cyanoacrylate and a thin polyurethane membrane.
  
  
  METHODS
  Prospective nonrandomized trial (Canadian Task Force classification II-1).
  
  
  METHODS
  Academic university hospital.
  
  
  METHODS
  Ten women undergoing minilaparotomy for adnexal masses.
  
  
  METHODS
  After obtaining institutional review board approval, we identified 10 patients who underwent minilaparotomy for treatment of adnexal masses not thought to be amenable to laparoscopic surgical management and with clinical, radiographic, and laboratory evaluation consistent with a low probability of malignancy. Charts were reviewed and data collected.
  
  
  RESULTS
  The median mass size was 17.5 cm (range 9-30 cm), median incision length was 4.0 cm (range 3-5.5 cm), median patient age was 29.5 years (range 19-41 years), median body mass index was 24.7 (range 19.4-30.7), median duration of surgery was 85 minutes (range 53-141 minutes). Blood loss was minimal in all cases and all patients were discharged on the day of surgery. There were no diagnoses of ovarian malignancy. Pathologic diagnoses included mature cystic teratomas, cystadenomas, and cystadenofibromas. There were no instances of intraabdominal leakage of cyst fluid. One patient required readmission for a postoperative ileus.
  
  
  CONCLUSIONS
  Minimally invasive management is a reasonable alternative to traditional laparotomy in the setting of a large adnexal mass with low probability of malignancy. This technique allows adequate access and exposure while minimizing the risk of intraabdominal contamination, speeding patient recovery, and optimizing cosmetic results. Further, this approach can be converted to a laparoscopic staging procedure if a patient is found to have ovarian cancer.
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan Medical Center, Women's Hospital, Ann Arbor, Michigan 48109-0276, USA.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Rhode
authors.forename: Arnold P
authors.initials: AP
authors.lastname: Advincula
authors.forename: R Kevin
authors.initials: RK
authors.lastname: Reynolds
authors.forename: William M
authors.initials: WM
authors.lastname: Burke
mesh_terms: D000291:Adnexal Diseases / Q000473:pathology / Q000601:surgery*; D000328:Adult; D003487:Cyanoacrylates; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000295:instrumentation / Q000379:methods*; D008567:Membranes, Artificial; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D011140:Polyurethanes; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D003487:Cyanoacrylates; D008567:Membranes, Artificial; D011140:Polyurethanes; C100832:octyl 2-cyanoacrylate