title: Laparoscopic removal of adnexal cysts: is it possible to decrease inadvertent intraoperative rupture rate?
abstract: OBJECTIVE
  The objective of the study was to characterize surgical risks for intraoperative rupture of benign adnexal lesions during laparoscopy.
  
  
  METHODS
  We conducted a retrospective review of cases of laparoscopic removal of ovarian cysts (adnexectomy or cystectomy) in our institution from 2002-2006, excluding procedures in which cysts were intentionally ruptured.
  
  
  RESULTS
  There were 256 operations (263 ovarian cysts). The patients' mean age was 40.9 +/- 15.8 years. The overall rate of inadvertent intraoperative rupture of cyst was 16.6% (adnexectomies 7.4% and conservative cystectomies 29.5%; P < .001). There was no significant correlation between inadvertent intraoperative rupture and adnexal torsion, pelvic adhesions, bilateral adnexal surgery, concomitant uterine surgery, presence of pelvic endometriotic foci, pregnancy, and surgeons' experience. Only cyst size and cystectomy procedure were positively and significantly associated with inadvertent cyst rupture (multivariate regression analysis).
  
  
  CONCLUSIONS
  Inadvertent intralaparoscopic rupture of adnexal cyst is significantly associated with cystectomies of large ovarian cysts for which laparotomy or laparoscopic-assisted extracorporeal cystectomy should be considered.
authors.affiliation: Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Zerifin, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Noam
authors.initials: N
authors.lastname: Smorgick
authors.forename: Oshri
authors.initials: O
authors.lastname: Barel
authors.forename: Reuvit
authors.initials: R
authors.lastname: Halperin
authors.forename: David
authors.initials: D
authors.lastname: Schneider
authors.forename: Moty
authors.initials: M
authors.lastname: Pansky
mesh_terms: D000291:Adnexal Diseases / Q000453:epidemiology / Q000601:surgery*; D000328:Adult; D015653:Cystectomy / Q000009:adverse effects* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D010535:Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D010048:Ovarian Cysts / Q000453:epidemiology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000453:epidemiology / Q000601:surgery; D011247:Pregnancy; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013724:Teratoma / Q000453:epidemiology / Q000601:surgery