Page 60 - World Journal of Laparoscopic Surgery

ORIGINAL RESEARCH
A Laparoscopic Approach of a Very Large Ovarian Cyst in

Young Female

Mukesh Carpenter

AbstrAct
Large ovarian cysts are ovary tumors with diameters more than 10 cm. Nowadays days these cases are rarely seen because they are diagnosed
and managed early due to the ease of access to good imaging modalities. Benign serous cystadenoma is the most common type of epithelial
neoplasm with benign serous cystadenoma ¾ and mucinous cystadenoma ¼. During the surgical management of large ovarian cysts in young
girls, the main goal to keep in mind is the preservation of the reproductive and hormonal function of the ovaries. In this paper, the author
represents a case report of a young female diagnosed with a very large ovarian cyst with a diameter of approximately 30 cm managed using
laparoscopic surgery.
Keywords: Benign ovarian cyst, Laparoscopy, Minimal access surgery, Ovary.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1496

IntroductIon
Department of Surgery, Alshifa Hospital, New Delhi, India
The most common cause of pelvic masses in women is ovarian Corresponding Author: Mukesh Carpenter, Department of Surgery,
cysts and the majority of the cases can be seen in the fertile age- Alshifa Hospital, New Delhi, India, Phone: +91 98999161704, e-mail:
group. In India, it has been observed that nearly 10% of the female drmukeshcarpenter@gmail.com
population undergo a surgical approach for ovarian cyst during her How to cite this article: Carpenter M. A Laparoscopic Approach
lifespan. Epithelial neoplasm of the ovary account for more than of a Very Large Ovarian Cyst in Young Female. World J Lap Surg
1
half of all ovarian tumors and almost 40% are benign tumors. Most 2022;15(1):58–64.
of the large ovarian cysts are benign and are generally treated via. Source of support: Nil
surgical excision such as cystectomy or salpingo-oophorectomy.
At the early stage, most cases seem to be asymptomatic and cause Conflict of interest: None
symptoms only after reaching a stage of massive dimension. The
clinical symptoms mainly include vaginal bleeding, progressive No bowel and urinary disturbance. No history of any gynecological
abdominal distension, early satiety, imprecise diffuse abdominal malignancy in the family. No history of any surgical intervention
pain, constipation, vomiting, and recurrent micturition. 2,3 in past.
Nowadays benign ovarian cysts of more than 10 cm are rarely On examination abdominal distended above the umbilicus
encountered due to early diagnosis and treatment. Laparoscopy bilateral flanks are full, fluid thrill present. Per vaginal examination
is the treatment of preference in most cases, but the size of the fullness is present mainly on the right side. Her routine blood
4
cyst can be a limiting factor. With the increased ovarian cyst size, investigation and serum tumor markers were well within the
the complication of a minimally invasive technique also increases normal range (Beta HCG—0.36 mIU/mL, CA125—8.6). Serum CA-125
due to problems in creating a pneumoperitoneum, decrease in assay is a useful tool that helps to distinguish between benign and
visibility and surgical mobility. All the listed factors result in a high malignant ovarian masses. The combination of normal findings
risk of intraoperative spillage. In literature, several case reports are at serum CA-125 assay, imaging, and clinical findings exclude the
present where different surgical techniques are used to reduce possibility of ovarian cancer. 8
abdominal spillage, but these techniques are not suitable for a
larger ovarian cyst that occupy the whole abdominal cavity. Sevelda Ultrasound
5
et al. also state that the intraoperative rupture of ovarian cyst did
not influence the prognosis. The author studied the survival of A large anechoic mass with internal septation arising from the
patients with moderately and poorly differentiated stage 1 ovarian pelvis extending up to epigastrium and bilateral lumbar region
carcinoma and concluded that no differences in the survival rate approximate size 28 cm × 23 cm × 20 cm, volume approximate
between the patients with intraoperative cyst rupture. 6,7 4875 mL, displacing the bowel and other visceral organs. Bilateral
ovaries are not separately visualized.

cAse PresentAtIon CECT Abdomen and Pelvis
My patient is a 26-year unmarried female belonging to a middle- Large nonenhancing capsulated thin-walled with internal septation
class family who came with complaints of progressive abdominal tubo-ovarian cystic mass arising from the right side of pelvis size
distension, vague abdominal pain, hyperacidity for a few 30 cm × 22 cm × 23 cm, volume almost 5000 mL occupying whole
months. She also gave a history of heavy flow during her last two abdomen extending up to epigastrium and bilateral lumbar region
menstruation cycles; her cycles are 28-days 3–4 days of bleeding. repelling the bowel and other visceral organs. Uterus pushed to

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