Laparoscopic management of adnexal masses in premenopausal and postmenopausal women

Objective: To evaluate the feasibility and safety of laparoscopic adnexal m ass removal in patients without preselection for benign pathology and asses s the operative complications and findings. Methods: All patients presenting to the gynecologic oncology service betwee n April 1992 and April 1996 with adnexal masses were candidates for laparos copic management. Patients underwent preoperative radiological studies and office pelvic examination. Laparoscopic management was attempted on patient s without evidence of gross metastatic disease or masses that extended abov e the umbilicus. Laparotomy was performed if indicated by pathologic findin gs or technical difficulty. All removed adnexal masses were sent for immedi ate pathologic diagnosis. The type of procedure, intraoperative findings, a nd complications were all recorded at the time of procedure. Results: One hundred sixty patients underwent laparoscopic evaluation for a n adnexal mass. Benign pathology was discovered in 139 (87%, 95% confidence interval [CI] 84, 90) patients, and 141 (88%, 95% CI 86, 91) patients were managed laparoscopically. Reasons for laparotomy included technical diffic ulty, operative complications, or malignancy. Frozen section diagnosis was concordant with the final pathology reports in all but five patients (97% c oncordance), and no discrepancies resulted in treatment delays. Conclusion: Laparoscopic management of adnexal masses can be successful in a gynecologic oncology population if there is expertise in operative laparo scopy, availability of immediate accurate pathologic examination, and appro priate further treatment where indicated. (Obstet Gynecol 1999;93:223-8. (C ) 1999 by The American College of Obstetricians and Gynecologists.).