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P479 Laparoscopic cystectomy in a very obese (115 kg) female with a huge benign ovarian cyst
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
P478 New method of treatment for genital Kochs in infertility: Laparoscopy and clinical diagnosis of Kochs. Is it really helpful in rural India? K. Barmade, M. Barmade, K. Jadhav, A. Barmade Materials and Methods: The study was done at Barmade hospital, Latur in rural India between feb 2007 to feb 2009 in human objects (female) age between 18 to 44 yrs, period of infertility ranging from 2 yrs to 25 yrs of married life. severe oligospermic and azoospermic male counterparts were not included in the study. Design of the study: 300 selected infertile female were included in the study from low socio-economic group, who underwent laparoscopy as a routine part of work up of female infertility. Clinical diagnosis of genital Kochs was made on the findings of beaded tubes, tubercles, hydrosalpinx, tubal block, tuberculoma, omental, and intestinal adhesions, Fitz-Hughes Curtis Syndrome. These patients were subjected to TB Ig M blood test. irrespective of result of TB Ig M patients were subjected to Anti Kochs Therapy for 6 months (2 months 4 drug and 4 months 3 drugs). Results: Out of 240 TB IgM positive patients 136 (56.66%) conceived, and out of 60 TB I g M negative patients 24 (40%) conceived. Conclusions: In rural parts as patients cant afford extra cost, and can not give guaranty of proper follow up. Also, ART is not affordable to this class of patients. If suspicion of tuberculosis is done on laparoscopy, then directly AKT (Anti tuberculosis therapy) should be given than doing costly tests like PCR RNA OR PCR DNA. It is a cost effective way to deal with rural people who can not afford extra cost for these tests. There is a possibility that few people may not return for getting results due to chaotic lifestyles. It is known in rural areas for people to give health as a low priority. Hence it is a good idea to treat them sooner than waiting for results of tests. The study also has limitations. Although participating patients were representative of the populations of the area it is important to have another study with large number of patients. Future research: As this study was done in a private setting, it is interesting to have similar study in tertiary care setting which is fully funded for poor people. P479 Laparoscopic cystectomy in a very obese (115 kg) female with a huge benign ovarian cyst D. Behera, D. Subramanium. Melaka General Hospital, Melaka, Malaysia Introduction: Ovarian cysts are fluid-filled, sac-like structures within an ovary. They can manifest from the “womb to tomb” i.e. from fetus, neonate, adolescence, adult to post menopause. Most of them are functional in nature and incidentally resolve. Persistent, progressive and painful cysts command judicious optimal interference. The overall incidence of ovarian cysts as follows: with regular, cyclical menstrual cycles 30%, females with irregular menses 50% and post-menopausal woman 6%. Ovarian tumor has been regarded as a silent killer with regards to its nature of presentation, difficulty in early diagnosis and unfortunately no preventive vaccine till date. Further in very obese females because of the unappreciable abdominal fat disposition it is difficult to ascertain clinically about the nature of the mass. With features of amenorrhoea or irregular menstrual cycles in unmarried woman asymptomatic huge ovarian mass sometimes embarrassing to question for anticipated pregnancy. Incidental findings in routine ultrasonography performed for other pelvic scenarios awaken and alert both dealing physicians and the patient about the nature of the cyst – whether malignant, benign, borderline or functional. With the advent and access of ultra sonography especially highresolution trans vaginal scan, now a great number of adnexal masses including ovarian cysts are well appreciated and accordingly the investigation and management follows. Asymptomatic ovarian
S549
mass management is still controversial while debate focusing on size, bilaterality, ultrasonographic configuration, Doppler – flow studies, associated pregnancy, and any specific documented reliable tumour markers. Symptomatic ovarian cysts and for benefits of doubt cases are usually intervened surgically either by laparotomy or by laparoscopic approach. The incidence of huge ovarian cyst is gradually in a diminishing trend in view of relatively better health care educational facilities, improvised counseling and easy access to hospitals. Laparotomy generally opted for huge ovarian cysts especially in highly obese cases with its advantage of wide exploration. In selected patients and with an experienced coordinated minimum invasive team, the same large ovarian cyst may be laparoscopically operated with the reported advantages of minimum intra and post operative morbidity, less bleeding, less likely adjacent organs injury, less postoperative analgesia, less hospital stay, early resume to usual work and marked appreciation for cosmetic scar. Objective: We are presenting in this case study: “To evaluate the safety and feasibility of laparoscopic approach for cystectomy in a an obese (115 kg) female with a huge 26 week size benign ovarian cyst.” Material and Methods: This is a retrospective case study undertaken at Melaka General Hospital, Melaka, Malyasia – a teaching tertiary hospital for under and postgraduate students.26 year single, unmarried, sexually inactive, obese (weight 115 kg, BMI 37) female was referred from district hospital on April 2007 with the history of progressive abdominal distension for about six months and worsening abdominal discomfort with irregular menstrual history for the preceding eight cycles. She attained menarche at 12 years of age and subsequent periods were regular, average and cyclical till the last eight months with features of oligo-menorrhoea. Her weight was drastically increased from 83 kg to 115 kg within last six to seven months in spite of her usual healthy life style. She experienced gradual progressive abdominal distension and last two months with irregular bowel habit of constipation. There was no history of vomiting or fainting attack or features of acute abdomen. For the last fifteen days before this admission she complained of easy fatigue ability with off and on exert ional dyspnoea for which she sought medical assistance in the local district institution from where she was referred to us. On examination, her vital signs were normal without any cardiorespiratory compromise. Physical examination revealed a large mass of about 26 weeks size, regular, tensely cystic, mildly tender, dull in percussion with restricted mobility in vertical direction, and without any ascites. Per rectal examination noted the mass was separate from the uterus without rectal involvement and was tensely cystic. Abdominal Ultrasound showed a right sided cystic mass, 17 cm × 19 cm size, thin regular outline with hypo echoic content in situ without any excrescences or mixed echoegenicity and without ascites with normal uterine configuration. Doppler ultrasound carried no increased vascularity. Hormonal assay like T4, TSH, FSH, LH, Testosterone and Oestradiol levels were normal. Tumor markers like CA125, CEA, AFP, and LDH were also found to be within normal limit. Chest x-ray was normal. CT abdomen and pelvis revealed right sided, unilocular ovarian cyst about 17 cm×19 cm size with clear fluid without any obvious metastasis and without any ascites. Liver, gallbladder, kidneys and bladder were normal. Routine investigations were up to normal values. She was diagnosed as a case of huge benign ovarian cyst most probably Serous cyst adenoma of Right ovary and planned for operative intervention. Patient was duly counseled about the diagnosis and advised for operative man oeuvre affording her the benefits and risks of open laparotomy versus laparoscopic approach. She understood the details discussion and given consent for laparoscopic intervention. She was planned for elective laparoscopic cytectomy under General Anesthesia.
S550
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
Under General Anesthesia and with lithotomic position, after due dressing, draping and catheterization (of course without any vaginal manipulation), the assistant grasped to stabilize the huge tumor mass and the Veress needle was carefully inserted about 8(eight) cm above the umbilicus and pneumo-peritoneum with carbon dioxide was carried up to 18 mmHg followed by the first 5 mm optic trocar insertion. Maximum precaution was warranted as the cyst was approaching up to the diaphragm and diaphragmatic excursions were eventually compromised. Later intra abdominal pressure reduced to 12 mm Hg. A large (about 26 weeks size), regular, thin walled cyst without any ascites or adhesions was localized. Under direct vision, 2nd 5 mm port was inserted at about 6 cm lateral to right side of umbilicus without any injury to the cyst wall and about 200 cc of normal saline was infused into the abdominal cavity and the peritoneal washings were retrieved for cytolology. By approximation of the huge cyst to the abdominal wall, cyst wall was punctured by three in one forceps needle and about 5.9 litres watery straw colored cystic contents were gently aspirated without any spillage. Later the punctured site of the cyst was grasped by Babcock forceps and was sealed off for any spillage. 3rd 10 mm port was introduced at left lower abdominal pariety. Whole intra abdominal organs were thoroughly inspected. Uterus, left ovary, fallopian tubes, liver, and gallbladder were normal without any adhesions to any structures. Laparoscopic Intra abdominal cystectomy of the right ovary was successfully performed. And the large cystic mass was extirpated by putting in to an endo-bag through 10 mm port. The edges of right ovary were approximated with 3–0 vicryl suture. Later the whole peritoneal cavity was thoroughly washed with about 5 (five) liters of saline and was sucked out. Prior to withdrawal of ports internal structures were meticulously inspected and no injury, no bleeding or oozing was detected Port sites were approximated with 3–0 vicryl sub cuticular stitches followed by dressing. Blood loss was less than 50 cc and operating time was about 55 minutes. Preoperative one dose of antibiotics and Postoperatively one dose of tramadol injection were given for analgesia. Patient was discharged after 18 hours of operation Postoperative follow up was uneventful. Patient resumed her usual job after one week. Results: Histopathology revealed benign serous cyst adenoma without any features of malignancy. This case study supports the reviewed literatures in assessing the safety and feasibility of minimum invasive approach for laparoscopic cystectomy even for giant ovarian cyst in a very obese woman with the usual benefits of minimum invasive surgery of less operative morbidities, less analgesia, early post operative ambulation with less hospital stay, early resume to work, appreciable cosmetic scar and also customer’s satisfaction. Conclusion: Laparoscopic cystectomy for very obese and with very large benign ovarian cyst can be feasible in selected cases and also a safe alternative.
pregnancy rate obtained was 25%. The rate of ectopic pregnancies was 40%, where all cases were patients with bilateral pathology. Conclusions: Based on the above results, Hydrosalpinx Reconstructive Surgery proved less cost-effective than IVF. Nevertherless, it is still an alternative for patients experiencing economic hardship, or those at the High Complexity Center who show ethical and/or religious objections in regards to assisted reproduction technologies, as well as for young patients with a slight unilateral pathology as their only cause of infertility. The selection of patients is a fundamental aspect to be considered.
P480 The role of hydrosalpinx reconstructive surgery in the assisted reproduction age
Media
A. Capurro, A. Illarramendi, C. Miranda. Uruguayan Society of Obstetrics and Gynecology Objectives: Defining current guidelines for hydrosalpinx reconstructive surgery. Materials and Methods: Design: Retrospective study. Location for development: Low Complexity Assisted Human Reproduction, University Hospital. Intervention: Results obtained with Hydrosalpinx Laparoscopic Reconstructive Surgery (Neosalpingostomy, Salpingoplast, Adhesiolysis) from January 2001 to December 2004. Main Outcome Measure(s): Primary results showed cumulative pregnancy rates, two years after surgery. Ectopic pregnancy rates were analyzed as a complication. Results: Laparoscopic surgery was performed on 40 patients for whom hydrosalpinx was the only cause of infertility. The cumulative
P481 Side-effects associated to surgical management of non-complex adnexal cysts in asymptomatic postmenopausal women A. Gorostiaga1 , I. Villegas1 , D. And´ıa. 1 Hospital San Francisco Javier, University of the Pays Basque, Bilbao, Spain, 2 Objective: To determine the side-effects (complications) associated to surgical management of ultrasonographically detected noncomplex adnexal cysts in an ovarian cancer screening program in postmenopausal women. Methods: Prospective analysis of 3378 postmenopausal women (at least 1 year since last period) who underwent transvaginal ultrasound (Phillips HDI 4000) as part of annual routine gynaecological exploration at our institution between January 2004 and December 2007. All patients to whom a non-complex adnexal cyst was diagnosed were offered surgical treatment or expectant management with serial transvaginal ultrasound at 3–6 month intervals. All the surgeries were performed by laparoscopy (oophorectomy or anexectomy) using an standarized 4 trocars acces (one 12 mm umbilical, one 12 mm suprapubic and two 5 mm suprailiacs) and an endobag to remove the specimen. Evolution and complications associated to the surgery were obtained. Results: 209 cysts in 207 women were diagnosed. 44 underwent laparoscopy, excising finally 49 cysts to diagnose 1 serous carcinoma and 1 serous “border-line” (prevalence: 0.059%). Surgical strategy was as described except for one case in which, due to the big size of the cyst, an ampliation of the 12 mm port was needed and four cases in which the trocar for the optic was introduced through a left subcostal access due to previous abdominal surgery. Complications were as follows: one case of thermical ileal injury that needed relaparotomy and mechanical respiratory support due to septic shock, one case of fever managed conservatively due to a pelvic hematoma in a case of complex residual endometrioma, one case of hematoma in a suprailiac access, resolved spontaneously and two cases of urinary lower tract infection treated with antibiotic monodosis. The mean time till discharge was 1.9 days (0.5–16) and the mean surgical time was 18 min (7–45 min). Results are shown in table I. Table I
Age CA-125 Size (cm) Days till discharge Surgical time Severe complications Slight complications
57.3 10.1 5.7 1.9 18 min 1 4
Conclusions: Though the results of our study show that conservative management in cases of non-complex adnexal cysts in the postmenopause is very safe option (risk of “hidden” ovarian cancer <1%), we also want to remark that, in terms of complications, the surgical management of patients screened for ovarian cancer who choose this option is also a very safe election when practiced by laparoscopy. At our institution, all the cases were managed via laparoscopy (except for the serous carcinoma which, in a second
P478 New method of treatment for genital Kochs in infertility: Laparoscopy and clinical diagnosis of Kochs. Is it really helpful in rural India? K. Barmade, M. Barmade, K. Jadhav, A. Barmade Materials and Methods: The study was done at Barmade hospital, Latur in rural India between feb 2007 to feb 2009 in human objects (female) age between 18 to 44 yrs, period of infertility ranging from 2 yrs to 25 yrs of married life. severe oligospermic and azoospermic male counterparts were not included in the study. Design of the study: 300 selected infertile female were included in the study from low socio-economic group, who underwent laparoscopy as a routine part of work up of female infertility. Clinical diagnosis of genital Kochs was made on the findings of beaded tubes, tubercles, hydrosalpinx, tubal block, tuberculoma, omental, and intestinal adhesions, Fitz-Hughes Curtis Syndrome. These patients were subjected to TB Ig M blood test. irrespective of result of TB Ig M patients were subjected to Anti Kochs Therapy for 6 months (2 months 4 drug and 4 months 3 drugs). Results: Out of 240 TB IgM positive patients 136 (56.66%) conceived, and out of 60 TB I g M negative patients 24 (40%) conceived. Conclusions: In rural parts as patients cant afford extra cost, and can not give guaranty of proper follow up. Also, ART is not affordable to this class of patients. If suspicion of tuberculosis is done on laparoscopy, then directly AKT (Anti tuberculosis therapy) should be given than doing costly tests like PCR RNA OR PCR DNA. It is a cost effective way to deal with rural people who can not afford extra cost for these tests. There is a possibility that few people may not return for getting results due to chaotic lifestyles. It is known in rural areas for people to give health as a low priority. Hence it is a good idea to treat them sooner than waiting for results of tests. The study also has limitations. Although participating patients were representative of the populations of the area it is important to have another study with large number of patients. Future research: As this study was done in a private setting, it is interesting to have similar study in tertiary care setting which is fully funded for poor people. P479 Laparoscopic cystectomy in a very obese (115 kg) female with a huge benign ovarian cyst D. Behera, D. Subramanium. Melaka General Hospital, Melaka, Malaysia Introduction: Ovarian cysts are fluid-filled, sac-like structures within an ovary. They can manifest from the “womb to tomb” i.e. from fetus, neonate, adolescence, adult to post menopause. Most of them are functional in nature and incidentally resolve. Persistent, progressive and painful cysts command judicious optimal interference. The overall incidence of ovarian cysts as follows: with regular, cyclical menstrual cycles 30%, females with irregular menses 50% and post-menopausal woman 6%. Ovarian tumor has been regarded as a silent killer with regards to its nature of presentation, difficulty in early diagnosis and unfortunately no preventive vaccine till date. Further in very obese females because of the unappreciable abdominal fat disposition it is difficult to ascertain clinically about the nature of the mass. With features of amenorrhoea or irregular menstrual cycles in unmarried woman asymptomatic huge ovarian mass sometimes embarrassing to question for anticipated pregnancy. Incidental findings in routine ultrasonography performed for other pelvic scenarios awaken and alert both dealing physicians and the patient about the nature of the cyst – whether malignant, benign, borderline or functional. With the advent and access of ultra sonography especially highresolution trans vaginal scan, now a great number of adnexal masses including ovarian cysts are well appreciated and accordingly the investigation and management follows. Asymptomatic ovarian
S549
mass management is still controversial while debate focusing on size, bilaterality, ultrasonographic configuration, Doppler – flow studies, associated pregnancy, and any specific documented reliable tumour markers. Symptomatic ovarian cysts and for benefits of doubt cases are usually intervened surgically either by laparotomy or by laparoscopic approach. The incidence of huge ovarian cyst is gradually in a diminishing trend in view of relatively better health care educational facilities, improvised counseling and easy access to hospitals. Laparotomy generally opted for huge ovarian cysts especially in highly obese cases with its advantage of wide exploration. In selected patients and with an experienced coordinated minimum invasive team, the same large ovarian cyst may be laparoscopically operated with the reported advantages of minimum intra and post operative morbidity, less bleeding, less likely adjacent organs injury, less postoperative analgesia, less hospital stay, early resume to usual work and marked appreciation for cosmetic scar. Objective: We are presenting in this case study: “To evaluate the safety and feasibility of laparoscopic approach for cystectomy in a an obese (115 kg) female with a huge 26 week size benign ovarian cyst.” Material and Methods: This is a retrospective case study undertaken at Melaka General Hospital, Melaka, Malyasia – a teaching tertiary hospital for under and postgraduate students.26 year single, unmarried, sexually inactive, obese (weight 115 kg, BMI 37) female was referred from district hospital on April 2007 with the history of progressive abdominal distension for about six months and worsening abdominal discomfort with irregular menstrual history for the preceding eight cycles. She attained menarche at 12 years of age and subsequent periods were regular, average and cyclical till the last eight months with features of oligo-menorrhoea. Her weight was drastically increased from 83 kg to 115 kg within last six to seven months in spite of her usual healthy life style. She experienced gradual progressive abdominal distension and last two months with irregular bowel habit of constipation. There was no history of vomiting or fainting attack or features of acute abdomen. For the last fifteen days before this admission she complained of easy fatigue ability with off and on exert ional dyspnoea for which she sought medical assistance in the local district institution from where she was referred to us. On examination, her vital signs were normal without any cardiorespiratory compromise. Physical examination revealed a large mass of about 26 weeks size, regular, tensely cystic, mildly tender, dull in percussion with restricted mobility in vertical direction, and without any ascites. Per rectal examination noted the mass was separate from the uterus without rectal involvement and was tensely cystic. Abdominal Ultrasound showed a right sided cystic mass, 17 cm × 19 cm size, thin regular outline with hypo echoic content in situ without any excrescences or mixed echoegenicity and without ascites with normal uterine configuration. Doppler ultrasound carried no increased vascularity. Hormonal assay like T4, TSH, FSH, LH, Testosterone and Oestradiol levels were normal. Tumor markers like CA125, CEA, AFP, and LDH were also found to be within normal limit. Chest x-ray was normal. CT abdomen and pelvis revealed right sided, unilocular ovarian cyst about 17 cm×19 cm size with clear fluid without any obvious metastasis and without any ascites. Liver, gallbladder, kidneys and bladder were normal. Routine investigations were up to normal values. She was diagnosed as a case of huge benign ovarian cyst most probably Serous cyst adenoma of Right ovary and planned for operative intervention. Patient was duly counseled about the diagnosis and advised for operative man oeuvre affording her the benefits and risks of open laparotomy versus laparoscopic approach. She understood the details discussion and given consent for laparoscopic intervention. She was planned for elective laparoscopic cytectomy under General Anesthesia.
S550
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
Under General Anesthesia and with lithotomic position, after due dressing, draping and catheterization (of course without any vaginal manipulation), the assistant grasped to stabilize the huge tumor mass and the Veress needle was carefully inserted about 8(eight) cm above the umbilicus and pneumo-peritoneum with carbon dioxide was carried up to 18 mmHg followed by the first 5 mm optic trocar insertion. Maximum precaution was warranted as the cyst was approaching up to the diaphragm and diaphragmatic excursions were eventually compromised. Later intra abdominal pressure reduced to 12 mm Hg. A large (about 26 weeks size), regular, thin walled cyst without any ascites or adhesions was localized. Under direct vision, 2nd 5 mm port was inserted at about 6 cm lateral to right side of umbilicus without any injury to the cyst wall and about 200 cc of normal saline was infused into the abdominal cavity and the peritoneal washings were retrieved for cytolology. By approximation of the huge cyst to the abdominal wall, cyst wall was punctured by three in one forceps needle and about 5.9 litres watery straw colored cystic contents were gently aspirated without any spillage. Later the punctured site of the cyst was grasped by Babcock forceps and was sealed off for any spillage. 3rd 10 mm port was introduced at left lower abdominal pariety. Whole intra abdominal organs were thoroughly inspected. Uterus, left ovary, fallopian tubes, liver, and gallbladder were normal without any adhesions to any structures. Laparoscopic Intra abdominal cystectomy of the right ovary was successfully performed. And the large cystic mass was extirpated by putting in to an endo-bag through 10 mm port. The edges of right ovary were approximated with 3–0 vicryl suture. Later the whole peritoneal cavity was thoroughly washed with about 5 (five) liters of saline and was sucked out. Prior to withdrawal of ports internal structures were meticulously inspected and no injury, no bleeding or oozing was detected Port sites were approximated with 3–0 vicryl sub cuticular stitches followed by dressing. Blood loss was less than 50 cc and operating time was about 55 minutes. Preoperative one dose of antibiotics and Postoperatively one dose of tramadol injection were given for analgesia. Patient was discharged after 18 hours of operation Postoperative follow up was uneventful. Patient resumed her usual job after one week. Results: Histopathology revealed benign serous cyst adenoma without any features of malignancy. This case study supports the reviewed literatures in assessing the safety and feasibility of minimum invasive approach for laparoscopic cystectomy even for giant ovarian cyst in a very obese woman with the usual benefits of minimum invasive surgery of less operative morbidities, less analgesia, early post operative ambulation with less hospital stay, early resume to work, appreciable cosmetic scar and also customer’s satisfaction. Conclusion: Laparoscopic cystectomy for very obese and with very large benign ovarian cyst can be feasible in selected cases and also a safe alternative.
pregnancy rate obtained was 25%. The rate of ectopic pregnancies was 40%, where all cases were patients with bilateral pathology. Conclusions: Based on the above results, Hydrosalpinx Reconstructive Surgery proved less cost-effective than IVF. Nevertherless, it is still an alternative for patients experiencing economic hardship, or those at the High Complexity Center who show ethical and/or religious objections in regards to assisted reproduction technologies, as well as for young patients with a slight unilateral pathology as their only cause of infertility. The selection of patients is a fundamental aspect to be considered.
P480 The role of hydrosalpinx reconstructive surgery in the assisted reproduction age
Media
A. Capurro, A. Illarramendi, C. Miranda. Uruguayan Society of Obstetrics and Gynecology Objectives: Defining current guidelines for hydrosalpinx reconstructive surgery. Materials and Methods: Design: Retrospective study. Location for development: Low Complexity Assisted Human Reproduction, University Hospital. Intervention: Results obtained with Hydrosalpinx Laparoscopic Reconstructive Surgery (Neosalpingostomy, Salpingoplast, Adhesiolysis) from January 2001 to December 2004. Main Outcome Measure(s): Primary results showed cumulative pregnancy rates, two years after surgery. Ectopic pregnancy rates were analyzed as a complication. Results: Laparoscopic surgery was performed on 40 patients for whom hydrosalpinx was the only cause of infertility. The cumulative
P481 Side-effects associated to surgical management of non-complex adnexal cysts in asymptomatic postmenopausal women A. Gorostiaga1 , I. Villegas1 , D. And´ıa. 1 Hospital San Francisco Javier, University of the Pays Basque, Bilbao, Spain, 2 Objective: To determine the side-effects (complications) associated to surgical management of ultrasonographically detected noncomplex adnexal cysts in an ovarian cancer screening program in postmenopausal women. Methods: Prospective analysis of 3378 postmenopausal women (at least 1 year since last period) who underwent transvaginal ultrasound (Phillips HDI 4000) as part of annual routine gynaecological exploration at our institution between January 2004 and December 2007. All patients to whom a non-complex adnexal cyst was diagnosed were offered surgical treatment or expectant management with serial transvaginal ultrasound at 3–6 month intervals. All the surgeries were performed by laparoscopy (oophorectomy or anexectomy) using an standarized 4 trocars acces (one 12 mm umbilical, one 12 mm suprapubic and two 5 mm suprailiacs) and an endobag to remove the specimen. Evolution and complications associated to the surgery were obtained. Results: 209 cysts in 207 women were diagnosed. 44 underwent laparoscopy, excising finally 49 cysts to diagnose 1 serous carcinoma and 1 serous “border-line” (prevalence: 0.059%). Surgical strategy was as described except for one case in which, due to the big size of the cyst, an ampliation of the 12 mm port was needed and four cases in which the trocar for the optic was introduced through a left subcostal access due to previous abdominal surgery. Complications were as follows: one case of thermical ileal injury that needed relaparotomy and mechanical respiratory support due to septic shock, one case of fever managed conservatively due to a pelvic hematoma in a case of complex residual endometrioma, one case of hematoma in a suprailiac access, resolved spontaneously and two cases of urinary lower tract infection treated with antibiotic monodosis. The mean time till discharge was 1.9 days (0.5–16) and the mean surgical time was 18 min (7–45 min). Results are shown in table I. Table I
Age CA-125 Size (cm) Days till discharge Surgical time Severe complications Slight complications
57.3 10.1 5.7 1.9 18 min 1 4
Conclusions: Though the results of our study show that conservative management in cases of non-complex adnexal cysts in the postmenopause is very safe option (risk of “hidden” ovarian cancer <1%), we also want to remark that, in terms of complications, the surgical management of patients screened for ovarian cancer who choose this option is also a very safe election when practiced by laparoscopy. At our institution, all the cases were managed via laparoscopy (except for the serous carcinoma which, in a second