Laparoscopic excision of ovarian dermoid cysts with controlled intraoperative spillage - Safety and effectiveness

OBJECTIVE: To compare the operative and postoperative course in patients un dergoing laparoscopy for dermoid cyst to that observed in subjects with oth er types of ovarian masses and of patients undergoing laparotomy for terato mas. STUDY DESIGN: Retrospective analysis. From 1994 to 1996, 49 women underwent laparoscopic cystectomy for dermoid cysts. The operative and postoperative course was compared to that of 190 patients undergoing operative laparosco py for other adnexal masses and to that of 43 patients undergoing laparotom y for dermoid cysts from 1992 to 1996. The cysts were aspirated to reduce s pillage and removed via a laparoscopic bag inserted in a 10-mm trocar. Culd otomy was never used. The abdominal cavity was abundantly flushed during th e procedure and before closure. RESULTS: Dermoid cystectomy was successfully performed laparoscopically in 47 of 49 cases. Spillage occurred in 43 cases (88%), and postoperative feve r occurred in 3 (6.1%). No case of peritonitis was recorded. Significant di fferences between laparoscopy and laparatomy were observed in the rate of b ilaterality (4% vs. 25%), spillage (88% vs. 9%) and mean hospital stay (37 vs. 83 hours). When laparoscopic excision of dermoid cysts and other masses was compared, we did not observe any significant difference in operative t ime or complication rates, apart from transient fever. CONCLUSION: Laparoscopy is safe and effective for dermoid cysts and allows shorter hospitalization than laparotomy. As observed for other benign cysts , laparoscopy should become the technique of choice for the removal of most , if not all, ovarian dermoid cysts.