title: Laparoscopic adnexectomy of suspect ovarian masses: surgical technique used to avert spillage.
abstract: Herein is described and evaluated a safe laparoscopic adnexectomy technique for retroperitoneal dissection of suspect ovarian masses including the underlying peritoneum fixed to the ovary. Adopting this technique in cases of suspect adnexal masses enables the reduction of spilling and ensures an intact specimen. Twenty-two consecutive patients with suspect adnexal masses 10 cm or smaller underwent laparoscopic adnexectomy. Patients with bilateral suspect ovarian masses that required bilateral adnexectomy were enrolled only if they were no longer of childbearing age. Laparoscopy was feasible in all patients. No tumor spillage occurred. In 5 patients (23.6%), minilaparotomy was required to extract the specimen. Mean (SD) operating time was 80 (35-160) minutes, and estimated blood loss was 50 (10-100) mL. No major intraoperative complications occurred. Median (range) postoperative stay was 1 (1-3) day. Definitive pathologic analysis revealed benign pathologic conditions in 18 patients (81.8%), an ovarian tumor with low malignant potential in 3 patients (13.7%), and ovarian cancer in 1 patient (4.5%) in whom findings at frozen-section analysis were inconclusive. Median (range) follow-up of malignant ovarian tumors and of tumors with low malignant potential was 27 (21-29) months. No recurrence or port-site metastasis developed during follow-up. The data are encouraging for adoption of this technique to avert spillage during laparoscopic management of suspect adnexal masses, especially those firmly adherent to the peritoneum. However, the procedure must be validated in a larger series of patients to standardize the technique.
authors.affiliation: 2nd Department of Obstetrics and Gynecology, Santa Chiara Hospital, Pisa, Italy. alessandra.perutelli@gmail.com
authors.forename: Alessandra
authors.initials: A
authors.lastname: Perutelli
authors.forename: Silvia
authors.initials: S
authors.lastname: Garibaldi
authors.forename: Stefano
authors.initials: S
authors.lastname: Basile
authors.forename: Chiara
authors.initials: C
authors.lastname: Baldacci
authors.forename: Antonio
authors.initials: A
authors.lastname: Gargini
authors.forename: Lavinia
authors.initials: L
authors.lastname: Domenici
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Salerno
mesh_terms: D000290:Adnexa Uteri / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult