Page 47 - World Journal of Laparoscopic Surgery

Multiple and Bilobed Ovarian Dermoid Cysts
Spillage of dermoid contents from the left-sided cystectomy the viability of the remaining tissue. There is a 3–4% risk of torsion
was unavoidable. Rest of the specimens were placed intact in an in ovarian mature cystic teratomas. An emergency laparoscopic
endo-bag made from urine bag and suctioned out from the 5 mm untwisting of adnexa is recommended. Persistent black color of
lower side port now converted into a 10 mm port. the adnexa after untwisting is not an indication of systematic
5
Thorough peritoneal lavage with warm saline was given, and oophorectomy since functional recovery is possible. In our case,
hemostasis was reconfirmed before closure. ovariotomy was kept as an alternative considering patient’s parity,
Postoperative recovery was uneventful. The patient was future need for fertility, and patient’s decision over the pathology.
discharged on the 3rd postoperative day. She was followed up on During the surgery, we proceeded with cystectomy on the left side
postoperative day 7 for suture removal with the histopathological and salpingo-oophorectomy on the right side.
confirmation of bilateral dermoid ovarian cyst.
conclusIon
dIscussIon Laparoscopy should be considered as a method of choice for mature
Dermoid cyst is a frequently encountered tumor of ovary, usually cystic teratomas of ovary. It should be performed by experienced
unilateral, sometimes bilateral, and rarely more than two in the advanced laparoscopic surgeons.
same patient. There are very few reports on multiple dermoid cysts We conclude that while dealing with dermoid cysts, the surgeon
2
in a patient. Bournas et al. documented four dermoid cysts within must evaluate the contralateral side also. The cyst wall must be
3
the right ovary and one in the contralateral ovary. Sinha et al. removed to prevent the possibility of recurrence.
described seven and three dermoid cysts in left and right ovaries, The risk of chemical peritonitis due to spillage in such cases is
respectively. Our case describes two dermoid cysts in the left ovary extremely less and can be easily managed with copious peritoneal
and one bilobed dermoid cyst, with torsion in the right ovary. lavage and with the use of endobag for specimen retrieval.
Before the advent of modern minimally invasive surgical
techniques, dermoid cysts produced some morbidity and mortality clInIcAl sIgnIfIcAnce
because of their propensity to undergo torsion leading to ovarian
infarction or rupture leading to chemical peritonitis. • Torsion of a dermoid cyst is not an absolute indication for
The use of laparoscopic technique reduces hospitalization, ovariotomy.
infection rate, and recovery time along with a cosmetically • Contralateral ovary must be examined while dealing with
acceptable scar. One of the theoretical pitfalls of laparoscopy is the cases of dermoid cyst as bilateral dermoid cysts are also a
assumed high risk of intraoperative cyst rupture leading to spillage possibility.
and chemical peritonitis. • Endobag can be made using a simple urobag, which is a
Kocak et al. described dermoid cyst extraction with spillage very economical method to prevent spillage of dermoid
in 42.5% cases and none developing chemical peritonitis. Berg contents.
et al. reported spillage in 66% cases in their study and no intra-
or postoperative complications and no evidence of chemical
peritonitis. Considering the literature on spillage rates in excision references
of dermoid cysts and the incidence of chemical peritonitis, the rate 1. Al-Fozan H, Glassman J, Caspi B, et al. Lateral distribution of ovarian
of clinical chemical peritonitis following spillage in laparoscopic dermoid cyst. J Am Assoc Gynecol Laparosc 2003;10(4):489–490. DOI:
dermoid cystectomy is <0.2%. 4 10.1016/s1074-3804(05)60152-1.
Spillage can be prevented by the use of an endobag or by 2. Bournas N, Varras M, Kassanos D, et al. Multiple dermoid cyst within
giving a thorough peritoneal lavage with warm fluids. It is our the same ovary:our experience of a rare case with review of the
routine practice to use the urobag as an endobag for such cases. In literature. Clin Exp Obstet Gynecol 2004;31(4):305–308.
fact, it can be argued that cyst contents spillage is easier and more 3. Sinha R, Sethi S, Mahajan C, et al. Multiple and bilateral dermoids:
efficiently managed during laparoscopy rather than laparotomy a case report. J Minim Invasive Gynecol 2010;17(2):235–238. DOI:
10.1016/j.jmig.2009.11.005.
because of better exposure of the pouch of Douglas and the 4. American College of Obstetricians and Gynecologists. ACOG
feasibility of extensive peritoneal lavage. Practice Bulletin. Management of adnexal masses. Obstet Gynecol
2007;110(1):201–214. DOI: 10.1097/01.AOG.0000263913.92942.40.
Oophorectomy vs Cystectomy 5. Deffieux X, Thubert T, Huchon C, et al. Complications of presumed
There are no data in the literature that prove the superiority of one benign ovarian tumors. J Gynecol Obstet Biol Reprod (Paris)
over the other. The decision is primarily based on fertility status and 2013;42(8):816–832. DOI: 10.1016/j.jgyn.2013.09.036.

World Journal of Laparoscopic Surgery, Volume 13 Issue 1 (January–April 2020) 45