The Trifecta: A Spill-Free, Fertility Sparing, Minimally Invasive Approach for a Large Adnexal Mass

Abstract

Study Objective

Demonstrate the safety and feasibility of laparoscopic-assisted extracorporeal ovarian cystectomy of a large benign adnexal mass. To exhibit spillage-free drainage methods in management of a large adnexal mass aligning with the goal of fertility-preservation in a patient with previous unilateral oophorectomy.

Design

Case presentation.

Setting

A university hospital.

Patients or Participants

31-yo G1P1001 with history of right oophorectomy presenting with abdominal pain/fullness, heartburn, and SOB. CT-A/P finding of a 24 cm adnexal mass described as multiloculated, mainly cystic with solid components that contain fat and calcification. Tumor markers were negative.

Interventions

Laparoscopic-assisted extracorporeal ovarian cystectomy of 24-cm adnexal mass by spill-free drainage techniques and fertility sparing intervention with reconstruction of the remaining left ovary.

Measurements and Main Results

The laparoscopic-assisted extracorporeal ovarian cystectomy was completed without complications including spillage with an EBL of 100 cc. The pathology confirmed a cystic mature teratoma. At post-operative follow-up in two weeks and six weeks, the patient was doing well without concerns with plans for pregnancy in the following year.

Conclusion

Laparoscopic-assisted extracorporeal ovarian cystectomy is a safe and minimally invasive approach for removal of large benign adnexal masses. The technique displayed in this video shows a spill-free drainage method for management of large adnexal masses by a minimally invasive approach.