Ovarian cysts are common in reproductive age women and usually benign. About 10% of women will eventually require surgical intervention. The laparoscopic approach is preferable as it’s associated with lower postoperative morbidity, cost efficient and shorter recovery time. However, it’s a dilemma when it comes to a huge ovarian cyst. We reported a case of young women with huge ovarian cyst who successfully underwent laparoscopic cystectomy.
A 19-year-old single Indian lady with no known medical illness and no malignancy profile presented with progressive abdominal distension for three weeks. Initial assessment, the patient was stable with BMI 36 and the abdomen was found to be distended with a mass palpable corresponds to 36 weeks uterine size. Ultrasonography imaging revealed huge ovarian cyst with no septation, solid area, and papillary projections. Further evaluation with CT scan of abdomen/pelvis showed ovarian mass measuring 15 cm x 21.6 cm x 25.6 cm. Biochemical evaluation including tumor markers were all in a normal range. Therefore laparoscopic was schedule under elective list.
The preoperation discussion was made to decompress the cyst prior to laparoscopic by using Cystofix. This Cystofix balloon punction set is a suprapubic catheter applied in acute urinary retention. It has the benefits of removing the cyst content without causing any spillage. It also has “3 wings” for better grip of the cannula.
During the procedure, the patient was cleaned and draped, and bladder was empty as usual manner. As the cyst was huge, a direct stab incision was made at the suprapubic area to decompress the cyst content using Cystofix cannula size 14F. Once content was observed, the catheter was introduced further to empty the content. Laparoscopic cystectomy was performed and left ovary reconstructed using two interrupted sutures Vicryl 3/0. The cyst wall was removed by using the sterile laparoscopic bag. Evaluation of procedure had shown it was comparable with normal cystectomy as it only required one hour with minimal blood loss. Postoperative was uneventful and she was discharged well. The pathological examination revealed a benign mucinous cystadenoma indicated that our surgery is complete treatment.
As discussion, the initial assessment showed ovarian cyst was benign in origin and laparoscopic approach with decompression of the ovarian cyst is achievable to avoid midline laparotomy incision which is conventionally used for surgical management of huge ovarian cyst. Overall we suggest that with a good patient selection and proper preoperative evaluation of nature of ovarian cyst, enormous ovarian cyst still can be removed laparoscopically by using this method.