This video demonstrates Laparoscopic Removal of Ovarian Teratoma by Dr. R.K. Mishra at World Laparoscopy Hospital. In most cases, ovarian mature cystic teratomas are asymptomatic with only 3-4% of women presenting with acute pelvic pain, which is usually due to torsion. There is no role for expectant management in such cases and they need emergency surgery. The risk of torsion is highest in ovarian mature cystic teratoma because of the long pedicle, and nearly all tort cases were 5-6 cm in size. Mature ovarian teratomas (dermoid cysts) are generally removed by laparoscopic surgery if the cyst is small. This involves a small incision in the abdomen to insert a scope and a small cutting tool. A small risk of laparoscopic removal is that the cyst can become punctured and leak waxy material. Unfortunately, there is no clinical, biological, or radiological sign that may exclude the diagnosis of adnexal torsion.

The presence of flow at color Doppler imaging does not allow the exclusion of the diagnosis. An emergency laparoscopy is recommended for adnexal untwisting, except in postmenopausal women where oophorectomy is recommended. A persistent black color of the adnexa after untwisting is not an indication of systematic oophorectomy since a functional recovery is possible. Ovariopexy is not routinely recommended following adnexal untwisting. These tumors rarely come back after being removed. If careful staging has determined that a grade 1 immature teratoma is limited to one or both ovaries, surgery to remove the ovary or ovaries containing cancer and the fallopian tube or tubes might be the only treatment needed.

Laparoscopic Removal of Ovarian Teratoma: A Minimally Invasive Approach to Treatment

Ovarian teratomas, also known as dermoid cysts, are among the most common benign ovarian tumors found in women of reproductive age. While often asymptomatic, larger teratomas can cause discomfort, pain, and complications such as ovarian torsion. In recent years, laparoscopic surgery has emerged as the preferred method for removing these cysts, offering patients a minimally invasive, effective, and safe treatment option.

Understanding Ovarian Teratomas
Ovarian teratomas are germ cell tumors composed of different tissue types, including hair, skin, teeth, and even bone. They can be categorized into mature (benign) and immature (potentially malignant) teratomas. The majority of cases involve mature cystic teratomas, which are slow-growing and rarely become cancerous. However, if left untreated, they can lead to complications such as rupture or infection.

Indications for Surgical Removal
Surgical removal of an ovarian teratoma is recommended in cases where:
- The cyst exceeds 5 cm in size
- The patient experiences persistent pelvic pain or pressure
- There is suspicion of malignancy
- Complications such as torsion, rupture, or infection occur
- The cyst continues to grow or affects surrounding structures

Laparoscopic Surgery: The Preferred Approach
Laparoscopic cystectomy is the gold standard for the removal of ovarian teratomas due to its numerous benefits over traditional open surgery. This technique involves small incisions in the abdomen through which a laparoscope and specialized surgical instruments are inserted. The key advantages of laparoscopic removal include:

- Minimal Scarring: Small incisions result in less visible scars compared to open surgery.
- Reduced Recovery Time: Most patients recover within a few days and can resume normal activities sooner.
- Lower Risk of Complications: Reduced blood loss, fewer infections, and minimal adhesions.
- Preservation of Ovarian Tissue: Surgeons aim to remove the cyst while maintaining ovarian function, which is particularly important for women desiring future pregnancies.

The Laparoscopic Procedure
The laparoscopic removal of an ovarian teratoma follows these steps:
1. Anesthesia Administration: The patient is placed under general anesthesia.
2. Insertion of the Laparoscope: A small incision is made near the navel, and a laparoscope is introduced to provide a magnified view of the pelvic organs.
3. Cyst Identification and Dissection: Using specialized instruments, the surgeon carefully separates the teratoma from the surrounding ovarian tissue.
4. Cyst Extraction: The cyst is placed in an endoscopic retrieval bag to prevent spillage and safely removed through a small incision.
5. Ovarian Repair and Closure: If necessary, the ovarian tissue is sutured, and the incisions are closed with absorbable sutures.

Postoperative Recovery and Outlook
Following laparoscopic surgery, most patients experience mild discomfort that can be managed with pain relievers. Recovery is typically quick, with most women returning to normal activities within one to two weeks. Follow-up visits ensure proper healing and rule out any postoperative concerns.

The prognosis after laparoscopic removal of an ovarian teratoma is excellent. Recurrence is rare, and fertility is usually preserved. Patients are advised to have regular gynecological check-ups to monitor ovarian health and detect any new cyst formation early.

Conclusion
Laparoscopic removal of ovarian teratomas is a safe and effective procedure that provides numerous benefits over conventional open surgery. With advancements in minimally invasive techniques, women can expect a smoother recovery, reduced complications, and optimal preservation of ovarian function. If diagnosed with an ovarian teratoma, consulting a gynecologic surgeon about laparoscopic options can help ensure the best possible outcome.


For more information:
World Laparoscopy Hospital
Cyber City, Gurugram, NCR Delhi
INDIA: +919811416838

World Laparoscopy Training Institute
Bld.No: 27, DHCC, Dubai
UAE: +971525857874

World Laparoscopy Training Institute
8320 Inv Dr, Tallahassee, Florida
USA: +1 321 250 7653