LAPAROSCOPIC MANAGEMENT OF SUSPICIOUS ADNEXAL MASSES

OBJECTIVE: Our aim was to evaluate the feasibility and applicability o f operative laparoscopy in the management of adnexal masses that do no t meet the standard serum CA 125 and ultrasonographic criteria for ben ignity. STUDY DESIGN: One hundred thirty-eight patients underwent oper ative laparoscopy for removal of suspicious adnexal masses. The CA 125 level was >35 mlU/ml in 39 of 138 (28%) patients; ultrasonographic fi ndings were abnormal in 127 of 138 (92%); masses were >10 cm in 43 of 138 (32%) of patients. RESULTS: Malignancies were discovered in 14% (1 9/138) of patients. Eight percent (11/138) of the procedures were conv erted to laparotomy, six because of inability to dissect the mass lapa roscopically and five for staging or debulking of carcinoma. Operative times ranged from 25 to 210 minutes; with a mean of 86. Three major c omplications were encountered-an enterotomy and a lacerated vena cava, both of which were repaired laparoscopically, and a small bowel herni ation through a lateral port site that required reoperation. Hospital stays ranged from 0 to 11 days, with a mean of 1.5. In two patients wi th ''apparent'' stage I adnexal carcinomas recurrence was diagnosed 6 and 38 months after surgery. CONCLUSIONS: Laparoscopic management of s uspicious adnexal masses is technically feasible, with a low rate of m orbidity and a short hospital stay. Adnexal carcinomas can be identifi ed and managed appropriately with staging and complete resection as in dicated.