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Laparoscopic management of large ovarian dermoid cysts in young women
Abstracts
146. Accuracy of Second-Look Laparoscopy Compared with Second-Look Laparotomy in Predicting Recurrence and Survival of Advanced Ovarian Cancer FR Nezhat, J Rahaman, P Oottino, T Jennings,
who underwent elective ovarian cystectomy were included in this preliminary study. Exclusion criteria were previous abdominal surgery, torsion of the ovary, and endometriosis or pelvic adhesions seen during surgery. Twenty operations were performed by laparoscopy and three by microsurgical minilaparotomy based on physicians' discretion. Second-look laparoscopy was carried out to evaluate adhesion formation and to perform adhesiolysis if necessary. There was no difference in cyst size between laparoscopy and minilaparotomy groups (6 _+1.6 and 8 + 3.6 cm, respectively, p = 0.6). Eight (34.8%) of 23 cysts were dermoid and 30.4% were serous cystadenomas. The remaining cysts were mucinous cystadenoma (3), corpus luteum (3), and simple (2). Adhesions were scored based on number and density. Adhesion scores after laparoscopy and minilaparotomy were 4.33 _ 3.2 and 0.45 _+0.8, respectively (p = 0.03). Conclusion. Intraabdominal laparoscopic cystectomy seems to cause fewer adhesions than extraabdominal microsurgical repair of the ovary.
C Cohen. Mount Sinai Medical Center, New York, New York.
Objective. To evaluate the accuracy of negative secondlook laparoscopy versus laparatomy in predicting progression-free interval (PFI) and survival in patients with stages III and 1V ovarian carcinoma. Measurements and Main Results. Of 345 consecutive woman treated for primary ovarian cancer, 230 were stage III and 35 stage IV, and 196 were eligible for second-look operations (no clinical evidence of disease) after primary surgical cytoreduction and platinumbased combination chemotherapy. Of 115 who underwent second-look procedure, 52 were negative. We compared 25 negative second-look laparoscopies (Lapsc) with 27 negative second-look laparotomies (Lap). The second-look PFI was defined as the interval between negative second-look and recurrence. Follow-up ranged from 8.3 to 159 months (median 52.7 too). The groups did not differ with respect to age, histology, grade, and optimal primary cytoreduction. Second-look PFI ranged from 5.7 to 145 months in the Lapsc group (mean 37.9 too, median 19 mo), compared with 5.7 to 130 months in the Lap group (mean 39.6 too, median 31.8 mo, NS). Survival in the Lapsc arm ranged from 15.4 to 159 months (mean 58.7 mo, median 47.1 too), compared with 8.3 to 140 months (mean 61.1 mo, median 62.4 too, NS) in the Lap arm. Conclusion. From this small series it appears that negative findings in women undergoing second-look laparoscopy do not translate to earlier recurrence or diminished survival compared with second-look laparotomy.
148. Laparoscopic Management of Large Ovarian Dermoid Cysts in Young Women ST Oh, SY Lee. Chonnam University Medical School, Kwangju, Korea.
Objective. To evaluate the possibility of laparoscopic cystectomy for large ovarian dermoid cysts in young women. Measurements and Main Results. Of 71 patients, 33 were below age 15 years, and of these, 15 had cysts larger than 6 cm. Cysts were classified type A or B according to contents. Type A had more fluid content than thick solid content, and type B were the opposite. In patients with type A, cystectomy was modified to minimize spillage of contents by aspiration and suture before dissection, and by immediate suction with suture for rupture. In the 33 patients younger than 15 years, 23 (81.8%) had type A cysts, compared with 5 (13.2%) of 38 older women (p <0.001). During surgery on type A cysts, no rupture occurred in 28 (87.5%) of 32 patients, rupture but no spillage in 4 (12.5%), and spillage in no patient. During surgery for type B cysts, no rupture occurred in 23 (58.2%) of 39 patients, rupture but no spillage in 13 (34.2%), and spillage in 3 (7.6%, p <0.05). In all patients younger than 15 years with cysts larger than 6 cm, cysts were type A, compared with 12 (66.7%) of 18 with smaller cysts (p <0.01). During surgery in the 33 young patients, there
147. Comparison of Second-Look Laparoscopy and Microsurgical Minilaparotomy after Ovarian Cystectomy G Oelsner, SE Elizur, DS Seidman, D Soriano, M Goldenberg, D Admon, S Mashiach. Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
Objective. To compare adhesion formation after ovarian cystectomy by laparoscopy and minilaparatomy. Measurements and Main Results: Twenty-three women of childbearing age (mean age 23 yrs, range 16-38 yrs)
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August 1999, Vol. 6, No. 3 Supplement The Journal of the American Association of Gynecologic Laparoscopists
were no ruptures in 1 (3.0%), rupture but no spillage in 3 (9.0%), and spillage in 29 (88%), compared with respective figures of 12.6%, 34.4%, and 53% in 38 older women (p <0.05). Conclusion. Large dermoid cysts in young patients have more fluid content, and laparoscopic cystectomy can be modified to minimize spillage.
149. Maintaining Normal Peritoneal Fluid Viscosity by Preconditioning Laparoscopic Gas
strain) increased from the normal 1.7 x 10-3 to 810 x 10-3 due to exposure to unconditioned raw gas. Conclusion. Resistance to shearing motion (viscosity) increases in peritoneal fluid due to exposure to raw gas. The change is directly related to the bone-dry condition of the gas, and affects peritoneal surface interactions and decreases normal lubricating quality of peritoneal fluid.
151. Israel Society of Gynecologic Endoscopy Survey, 1998
DE Ott. Mercer University, School of Engineering, Macon, Georgia.
M Pansky, A Abargel, R Langer, I Bukovsky. Assaf Harofe Medical Center, Zerifin, Israel.
Objective. To determine the effect of filtering, heating, and hydrating laparoscopic gas on peritoneal fluid viscosity. Measurements and Main Results. Analysis of peritoneal fluid viscosity was performed in vivo and in vitro using raw and conditioned insuffiation gas with and without a filtering, heating, hydrating device. Fortyfive women (age 25-42 yrs) served as their own controls with samples of peritoneal fluid taken before, during, and after insuffiation gas exposure. Peritoneal fluid viscosity dramatically increased with exposure to raw gas, and was directly related to flow rate and volume of gas. Viscosity was normal when gas was filtered, heated, hydrated, and preconditioned. Conclusion. Frictional changes due to damaging effects of peritoneal drying caused by raw insuffiation gas increase the contact surface area where peritoneal fluid activity is most important. Increased viscosity and loss of lubricating quality of peritoneal fluid cause the interaction of tissue surfaces to become detrimentally altered. The lubricating quality is maintained by filtering, heating, and hydrating insuffiation gas.
Objective. To document the nature and distribution of laparoscopy and laparoscopic complications in Israel. Measurements and Main Results. A survey questionnaire was prepared and sent to the 26 gynecologic departments in Israel. Overall response rate was 50%, excellent when compared with other national surveys on the same subject. The most frequent indications for operative laparoscopy were ovarian pathology (50%) and ectopic pregnancy (25%). Rate of major complications, which included vascular, bowel, and urinary tract injuries, was 6.5/1000 and of minor complication was 8/1000. Conclusion. The overall response to the survey was relatively high and the rate of complications was comparable with those in most other national studies.
152. Evaluation of Various Therapeutic Modalities in Treatment of Uterine Myomas KH Park, JE Yeon, SW Bai, lW Kim. Medical College, Yonsei University, Seoul, Korea.
Objective. To evaluate resectoscopic myomectomy, laparoscopic myomectomy, and LAVH in treatment of uterine myomas. Measurements and Main Results. The procedures were performed in 136 women with uterine myomas. Mean operating time was longer for LAVH than for laparoscopic myomectomy, and longer for laparoscopic myomectomy than for resectoscopic myomectomy (123 + 5.3 vs 85.0 + 10.3 vs 41 _ 14 min, p = 0.001). Mean blood loss was greater for LAVH than for laparoscopic myomectomy, and greater for laparoscopic myomectomy group than for resectoscopic myomectomy (343 +_37 vs 166 + 28 vs 98 -4-25 ml, p = 0.001). Conclusion. The therapeutic effect of endoscopic surgery can be maximized by carefully selecting
150. Changes in Peritoneal Fluid Viscosity Due to Raw Gas at Laparoscopy DE Ott. Mercer University, School of Engineering, Macon, Georgia.
Objective. To assess changes in viscosity of peritoneal fluid during laparoscopy as a result of gas insuffiation. Measurements" and Main Results. Peritoneal fluid was tested for changes in viscosity as measured by viscometric methods and mathematical modeling. Control and various timed and flow rate conditions were evaluated. Over a range of conditions coefficient of viscosity (ratio of shearing stress to rate of change of shear
$43
146. Accuracy of Second-Look Laparoscopy Compared with Second-Look Laparotomy in Predicting Recurrence and Survival of Advanced Ovarian Cancer FR Nezhat, J Rahaman, P Oottino, T Jennings,
who underwent elective ovarian cystectomy were included in this preliminary study. Exclusion criteria were previous abdominal surgery, torsion of the ovary, and endometriosis or pelvic adhesions seen during surgery. Twenty operations were performed by laparoscopy and three by microsurgical minilaparotomy based on physicians' discretion. Second-look laparoscopy was carried out to evaluate adhesion formation and to perform adhesiolysis if necessary. There was no difference in cyst size between laparoscopy and minilaparotomy groups (6 _+1.6 and 8 + 3.6 cm, respectively, p = 0.6). Eight (34.8%) of 23 cysts were dermoid and 30.4% were serous cystadenomas. The remaining cysts were mucinous cystadenoma (3), corpus luteum (3), and simple (2). Adhesions were scored based on number and density. Adhesion scores after laparoscopy and minilaparotomy were 4.33 _ 3.2 and 0.45 _+0.8, respectively (p = 0.03). Conclusion. Intraabdominal laparoscopic cystectomy seems to cause fewer adhesions than extraabdominal microsurgical repair of the ovary.
C Cohen. Mount Sinai Medical Center, New York, New York.
Objective. To evaluate the accuracy of negative secondlook laparoscopy versus laparatomy in predicting progression-free interval (PFI) and survival in patients with stages III and 1V ovarian carcinoma. Measurements and Main Results. Of 345 consecutive woman treated for primary ovarian cancer, 230 were stage III and 35 stage IV, and 196 were eligible for second-look operations (no clinical evidence of disease) after primary surgical cytoreduction and platinumbased combination chemotherapy. Of 115 who underwent second-look procedure, 52 were negative. We compared 25 negative second-look laparoscopies (Lapsc) with 27 negative second-look laparotomies (Lap). The second-look PFI was defined as the interval between negative second-look and recurrence. Follow-up ranged from 8.3 to 159 months (median 52.7 too). The groups did not differ with respect to age, histology, grade, and optimal primary cytoreduction. Second-look PFI ranged from 5.7 to 145 months in the Lapsc group (mean 37.9 too, median 19 mo), compared with 5.7 to 130 months in the Lap group (mean 39.6 too, median 31.8 mo, NS). Survival in the Lapsc arm ranged from 15.4 to 159 months (mean 58.7 mo, median 47.1 too), compared with 8.3 to 140 months (mean 61.1 mo, median 62.4 too, NS) in the Lap arm. Conclusion. From this small series it appears that negative findings in women undergoing second-look laparoscopy do not translate to earlier recurrence or diminished survival compared with second-look laparotomy.
148. Laparoscopic Management of Large Ovarian Dermoid Cysts in Young Women ST Oh, SY Lee. Chonnam University Medical School, Kwangju, Korea.
Objective. To evaluate the possibility of laparoscopic cystectomy for large ovarian dermoid cysts in young women. Measurements and Main Results. Of 71 patients, 33 were below age 15 years, and of these, 15 had cysts larger than 6 cm. Cysts were classified type A or B according to contents. Type A had more fluid content than thick solid content, and type B were the opposite. In patients with type A, cystectomy was modified to minimize spillage of contents by aspiration and suture before dissection, and by immediate suction with suture for rupture. In the 33 patients younger than 15 years, 23 (81.8%) had type A cysts, compared with 5 (13.2%) of 38 older women (p <0.001). During surgery on type A cysts, no rupture occurred in 28 (87.5%) of 32 patients, rupture but no spillage in 4 (12.5%), and spillage in no patient. During surgery for type B cysts, no rupture occurred in 23 (58.2%) of 39 patients, rupture but no spillage in 13 (34.2%), and spillage in 3 (7.6%, p <0.05). In all patients younger than 15 years with cysts larger than 6 cm, cysts were type A, compared with 12 (66.7%) of 18 with smaller cysts (p <0.01). During surgery in the 33 young patients, there
147. Comparison of Second-Look Laparoscopy and Microsurgical Minilaparotomy after Ovarian Cystectomy G Oelsner, SE Elizur, DS Seidman, D Soriano, M Goldenberg, D Admon, S Mashiach. Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
Objective. To compare adhesion formation after ovarian cystectomy by laparoscopy and minilaparatomy. Measurements and Main Results: Twenty-three women of childbearing age (mean age 23 yrs, range 16-38 yrs)
$42
August 1999, Vol. 6, No. 3 Supplement The Journal of the American Association of Gynecologic Laparoscopists
were no ruptures in 1 (3.0%), rupture but no spillage in 3 (9.0%), and spillage in 29 (88%), compared with respective figures of 12.6%, 34.4%, and 53% in 38 older women (p <0.05). Conclusion. Large dermoid cysts in young patients have more fluid content, and laparoscopic cystectomy can be modified to minimize spillage.
149. Maintaining Normal Peritoneal Fluid Viscosity by Preconditioning Laparoscopic Gas
strain) increased from the normal 1.7 x 10-3 to 810 x 10-3 due to exposure to unconditioned raw gas. Conclusion. Resistance to shearing motion (viscosity) increases in peritoneal fluid due to exposure to raw gas. The change is directly related to the bone-dry condition of the gas, and affects peritoneal surface interactions and decreases normal lubricating quality of peritoneal fluid.
151. Israel Society of Gynecologic Endoscopy Survey, 1998
DE Ott. Mercer University, School of Engineering, Macon, Georgia.
M Pansky, A Abargel, R Langer, I Bukovsky. Assaf Harofe Medical Center, Zerifin, Israel.
Objective. To determine the effect of filtering, heating, and hydrating laparoscopic gas on peritoneal fluid viscosity. Measurements and Main Results. Analysis of peritoneal fluid viscosity was performed in vivo and in vitro using raw and conditioned insuffiation gas with and without a filtering, heating, hydrating device. Fortyfive women (age 25-42 yrs) served as their own controls with samples of peritoneal fluid taken before, during, and after insuffiation gas exposure. Peritoneal fluid viscosity dramatically increased with exposure to raw gas, and was directly related to flow rate and volume of gas. Viscosity was normal when gas was filtered, heated, hydrated, and preconditioned. Conclusion. Frictional changes due to damaging effects of peritoneal drying caused by raw insuffiation gas increase the contact surface area where peritoneal fluid activity is most important. Increased viscosity and loss of lubricating quality of peritoneal fluid cause the interaction of tissue surfaces to become detrimentally altered. The lubricating quality is maintained by filtering, heating, and hydrating insuffiation gas.
Objective. To document the nature and distribution of laparoscopy and laparoscopic complications in Israel. Measurements and Main Results. A survey questionnaire was prepared and sent to the 26 gynecologic departments in Israel. Overall response rate was 50%, excellent when compared with other national surveys on the same subject. The most frequent indications for operative laparoscopy were ovarian pathology (50%) and ectopic pregnancy (25%). Rate of major complications, which included vascular, bowel, and urinary tract injuries, was 6.5/1000 and of minor complication was 8/1000. Conclusion. The overall response to the survey was relatively high and the rate of complications was comparable with those in most other national studies.
152. Evaluation of Various Therapeutic Modalities in Treatment of Uterine Myomas KH Park, JE Yeon, SW Bai, lW Kim. Medical College, Yonsei University, Seoul, Korea.
Objective. To evaluate resectoscopic myomectomy, laparoscopic myomectomy, and LAVH in treatment of uterine myomas. Measurements and Main Results. The procedures were performed in 136 women with uterine myomas. Mean operating time was longer for LAVH than for laparoscopic myomectomy, and longer for laparoscopic myomectomy than for resectoscopic myomectomy (123 + 5.3 vs 85.0 + 10.3 vs 41 _ 14 min, p = 0.001). Mean blood loss was greater for LAVH than for laparoscopic myomectomy, and greater for laparoscopic myomectomy group than for resectoscopic myomectomy (343 +_37 vs 166 + 28 vs 98 -4-25 ml, p = 0.001). Conclusion. The therapeutic effect of endoscopic surgery can be maximized by carefully selecting
150. Changes in Peritoneal Fluid Viscosity Due to Raw Gas at Laparoscopy DE Ott. Mercer University, School of Engineering, Macon, Georgia.
Objective. To assess changes in viscosity of peritoneal fluid during laparoscopy as a result of gas insuffiation. Measurements" and Main Results. Peritoneal fluid was tested for changes in viscosity as measured by viscometric methods and mathematical modeling. Control and various timed and flow rate conditions were evaluated. Over a range of conditions coefficient of viscosity (ratio of shearing stress to rate of change of shear
$43