Laparoscopic intervention for ovarian cyst is good practice. However removing cyst wall following cystectomy always a challenge for minimally invasive procedure. Therefore, various methods had been reported using fancy and advanced tools to facilitate the removal procedure hence improved the operative time and outcome. In a low-resource center like Sungai Petani, surgeon always struggling with minimal budget and equipment that lead to minimal laparoscopic implementation. Despite that, we manage to advocate a cystectomy in huge benign ovarian cyst and removal of the cyst wall was done by using a daily food container plastic bag as our innovation practice.
We describe a technique for the management of large benign ovarian cysts by ordinary laparoscopic surgery. However, despite using an EndobagTM, we implement a normal food container plastic bag to facilitate removal of the cyst content as it is cheap and easily available. This plastic bag was sterilized using a standard sterilization procedure based on our local hospital protocol. As we know the overall of intra-abdominal working space in large ovarian cysts poses a technical challenge. Moreover, difficult to open the food container plastic bag using the operating instruments and easily tearing of the plastic material makes the procedure quite demanding, especially during transferring the specimen into the bag. Trocar size 10 mm is used to insert the plastic bag and remove the content. Here, the concept is providing an adequate plastic opening at the pouch of Douglas (POD) where it act as a base and later using a gravity effect to transfer the cyst content into the plastic bag. The tedious part is to remove the content intact in the bag where we need to cut the content into a smaller and compressible structure so it can easily mold to facilitate the removal. Constant but medium pressure is applied to ensure the bag is intact and the cyst material is content to avoid spillage. The content then brought as near as possible to the skin incision and artery forceps was used to remove the content manually until all the bag was able to pull out intact. This method provides an excellent way of removal the cyst content from the abdominal wall, making it convenient to practice it in the low resource center. This technique demonstrates that removal of ovarian cyst content during cystectomy is feasible, safe and technically unchallenging even in large benign ovarian cysts by using a simple food container plastic bag as a good innovation practice as compare to expensive conventional laparoscopic Endobag.
Keywords: Cystectomy, laparoscopy, ovarian, low resource, plastic bag