LAPAROSCOPIC MANAGEMENT OF ADNEXAL MASSES SUSPICIOUS AT ULTRASOUND

Objective: To evaluate the laparoscopic management of adnexal masses s uspicious at ultrasound. Methods: In a prospective study, adnexal mass es suspicious at ultrasound were managed by laparoscopy. Indications f or laparotomy included general contraindications to laparoscopy, obvio usly disseminated ovarian cancer, and technically impossible laparosco pic treatment. After laparoscopic diagnosis, frozen sections were used to confirm a diagnosis of malignancy. Treatment was performed by lapa roscopy whenever feasible. Results: Over a 3-year period, 247 of the 5 99 adnexal masses (41.2%) treated in our department were suspicious or solid at ultrasound. Seventeen patients were evaluated by laparotomy and 230 by laparoscopy. Overall, 204 women (82.6%) were treated by lap aroscopy, including seven of the 37 malignant tumors (18.9%) and 197 o f the 210 benign masses (93.8%). One case of tumor dissemination occur red after a laparoscopic adnexectomy and morcellation of a grade 1 imm ature teratoma. Conclusion: Laparoscopic diagnosis of adnexal masses s uspicious at ultrasound avoids many laparotomies for the treatment of benign masses and allows an improved inspection of the upper abdomen. The laparoscopic treatment of adnexal masses suspicious at surgery sho uld be evaluated further in carefully designed prospective studies. (C ) 1997 by The American College of Obstetricians and Gynecologists.