title: Laparoscopic management of large ovarian cysts at a rural hospital.
abstract: OBJECTIVE
  To assess the feasibility and outcome of laparoscopic surgery for the management of large ovarian cysts at a rural hospital.
  
  
  METHODS
  Fifteen patients from March 2004 to February 2007, with large ovarian cysts, with diameter >10 cm, were managed laparoscopically. The masses were cystic and were not associated with ascites or enlarged lymph nodes on ultrasound. Serum CA-125 levels were within the normal range (35 U/ml). Preoperative evaluation included history, clinical examination, sonographic images and serum markers. The management of these ovarian cysts included aspiration, cystectomy or salphingo-oophorectomy, depending on the patient's age, obstetric history and desire of future fertility. In large, solid, fixed or irregular adnexal masses, suspicious of malignancy, laparotomy was done.
  
  
  RESULTS
  Five patients presented with pain in the abdomen and 10 patients with abdominal distension and discomfort. The average maximum diameter of the ovarian cysts was 16.75 cm (range 10-24 cm). The mean duration of the operation was 80 min. The postoperative hospital stay was from 4 to 6 days. No intraoperative complications occurred and the hospital course of all patients was uncomplicated. In one case, laparoscopy was converted to laparotomy. One patient had minor wound infection at umbilical port site. The patients did not report any complaints during follow up and the clinical examination findings were normal in all, up to 9 months after discharge.
  
  
  CONCLUSIONS
  With proper patient selection, the size of an ovarian cyst is not necessarily a contraindication for laparoscopic surgery.
authors.affiliation: Vishwajyoti Nursing Home and Laparoscopic Surgical Centre, APMC Circle, Gokak 591 307, Karnataka.
authors.forename: Vishwanath V
authors.initials: VV
authors.lastname: Shindholimath
authors.forename: S G
authors.initials: SG
authors.lastname: Jyoti
authors.forename: K V
authors.initials: KV
authors.lastname: Patil
authors.forename: A S
authors.initials: AS
authors.lastname: Ammanagi