Complete resection of adnexal masses with endobag extraction: the risk of involuntary tumour rupture

Objective In a prospective study we analysed the frequency of intraoperativ e capsule rupture among 161 ovarian tumours operated on endoscopically, usi ng total removal of the adnexa with protected retrieval. Subjects and methods Between June 1993 and September 1997 we carried out en doscopic surgery on 161 consecutive patients, presenting with ovarian tumou rs up to 10 cm in diameter, and assumed to have an increased risk for malig nancy on the basis of menopausal status, sonography findings or endoscopic evaluation. The risk of tumour rupture was related to the different phases of the operation (resection and extraction) and to the presence and locatio n of intra-abdominal adhesions. Results Malignancies were found in 6.83% of the patients. Capsule rupture o ccurred in 13 cases (8%). There was no instance of malignant cell spillage because of intraoperative capsule rupture. The statistical probability of m alignant cell dissemination was 0.55% in our series. During resection, rupt ure of suspicious but not malignant tumours occurred in six cases (3.7%). T he probability of spilling cyst contents was closely associated with the pr esence and the location of intra-abdominal adhesions, the highest spillage rate (16.6%) being found in tumours with adhesions to intestine. During ext raction, contamination on account of bag rupture occurred in seven cases (4 .3%). Conclusion Using adequate endoscopic resection and removal techniques, susp icious ovarian tumours under 10 cm in diameter can be operated on endoscopi cally with a low risk of tumour rupture.