Excision of mature teratoma using culdotomy, with and without laparoscopy:a prospective randomised trial

Objective To compare the results of removing mature teratoma with laparosco py or without laparoscopy. Design A prospective, randomised trial. Setting Medical centre. Participants Seventy-nine women with mature teratomas identified using resu lts of ultrasound examinations and biochemical markers. Intervention Cystectomy with laparoscopic approach or without laparoscopic approach through a culdotomy. Methods Patients were randomly assigned to have their cysts removed via vag inal cystectomy without laparoscopy (n = 37, Group A) or laparoscopic cyste ctomy via culdotomy opening (n = 32, Group B). Inclusion criteria were hist ory of vaginal delivery, no previous abdominal surgery, no history of pelvi c inflammatory disease, no medical illness, and no presenting symptoms. Eig ht women randomised to Group A withdrew before surgery. The laparoscopicall y resected tumours were each put into a cellulose bag, and tumours without laparoscopic-assistance were removed directly via the vagina. Results Blood loss in Group A (88 +/- 37 ml) was significantly more than th at in Group B (64 +/- 20 ml, P = 0.000). The post-operative recovery times were 20 and 17 hours, respectively (P = 0.030). The rates of successful sur gery were 58.6 and 97.6%, respectively (P = 0.002). The spillage rates were 44.8% and 19.0%, respectively (P = 0.006). There were no significant diffe rences in tumour size, patient age, and operative time between groups. Conclusion Cystectomy without assistance of laparoscopy could be applied to manage mature teratoma of the ovary, however, because of the difficulty of this technique, we had high percentages of tumour spillage and mol e blood loss during operation and a high percentage of patients who required conve rsion to laparotomy compared with laparoscopic cystectomy. We favoured lapa roscopically assisted cystectomy to manage mature teratoma.