A cystectomic technique with low risk of rupture for women with benign ovarian cyst

Abstract

The majority of patients with benign ovarian cysts undergo laparoscopic surgery using both cystectomy and stripping techniques. However, these techniques have difficulty correctly identifying cleavage planes and are prone to cyst rupture. We present a surgical cystectomy technique that correctly identifies the cleavage plane with a low risk of ovarian cyst rupture, even in patients with multicystic ovarian cysts. Cystectomy was performed using Maryland forceps with gentle open and close dissecting motions only. Both the surgeon and assistant handled the ovarian cortex and cyst wall, and soft traction between the cortex and cyst wall as far as the nearby dissection plane without grasping the cyst wall was essential. In patients with multicystic ovarian cysts, making a plane at the notch between cysts decreases the risk of cyst rupture. This technique allows the correct identification of the cleavage plane for dissection and avoids the risk of cyst rupture.

Impact Statement

• What is already known on this subject? The majority of patients with benign ovarian cysts undergo laparoscopic surgery using both cystectomy and stripping techniques. These techniques have difficulty correctly identifying cleavage planes and are prone to cyst rupture.

• What do the results of this study add? This technique allows the correct identification of the cleavage plane for dissection and avoids the risk of cyst rupture.

• What are the implications of these findings for clinical practice and/or further research? Our technique might be useful for the preservation of the ovarian reserve because patients in this study had a low proportion of ovarian follicles in the surgical specimen.

Keywords:

• Laparoscopy
• ovarian cyst
• rupture
• cystectomy
• multicystic

Acknowledgements

The authors thank Editage (www.editage.com) for English language editing and publication support.

Disclosure statement

K. Chikazawa received lecture honoraria from ETHICON (Tokyo, Japan). R. Konno received research funding from Yakult Pharmaceutical Industry Co. (Tokyo, Japan) and Chugai Pharmaceutical Co. (Tokyo, Japan), as well as lecture honoraria from Japan Vaccine Co. (Tokyo, Japan), MSD Japan (Tokyo, Japan) and Chugai Pharmaceutical Co. (Tokyo, Japan).