Laparoscopic Managment of Adnexal Mass

Prof. Dr. Fuat DemirkıranI.U Cerrahpaşa School of Medicine.

Department of OB&GYN Division Of Gynocol Oncol

TJOD 2012 Antalya,

%80 benign masses

%10-15 malignant masses

%5 Metastatic masses

Adnexal Masses

Ultrasonography

Tumor Markers

ConventionalDoppler

3D-4D

Other Imaging TechniquesBT MR PET-CT

Management of Adnexal Mass

USG-guided Cyst Aspiration

Laparoscopic SurgeryOpen Abdominal Surgery

Follow-Up

Laparoscopy is associated with a reduction in the following:

febrile morbidity, urinary tract infection, postoperative complications, postoperative pain,

days in hospital,and total cost.

Low risk masses formalignancy

Manystudies document that, after carefulpreoperative screening, the relative frequency of encountering a malignancyduring laparoscopic evaluation is low(2%).

Cystadenomas

Endometrioma

Solid Mass

Dermoid cysts

There were no operative or postoperative complications related to cyst content spillage,

regardless of the surgical approach.

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Frozen –section evaluation

Malignant masses

What about laparoscopic surgery for malignant adnexal mases

Laparoscopic surgery for Ovarian Cancer

The adequacy of minimally invasive surgery compared to traditional laparotomy for staging.

The risk of tumor cyst rupture.

The incidence and long-term implicationsof port-site metastases.

The effect of CO2 pneumoperitoneum on tumor growth.

results suggest that laparoscopic comprehensive surgical staging of EOC is as safe and adequate as the standard surgical

staging performed via laparotomy.

Gynecologic Oncology 105 (2007) 409–413

33%

75%

Cyst rupture

Prognostic Effect of Cyst Rupture

increase stage Un-change stage

author n author n

Gleeson NC 23 Sevelda P 60

Lehner R 70 Kruitwagen RF 219

Leminen A 154 Ahmed FY 194

Vergote I154

5 Abu-Rustum NR 289

Gleeson NC, Am J Obstet Gynecol, 2001; Sevelda P, Gynecol Oncol, 1989Lehner R, Obstet Gynecol, 1998; Kruitwagen RF, Gynecol Oncol, 1996

Leminen A, Gynecol Oncol, 1999; Ahmed FY, J Clin Oncol, 1997Vergote I, Lancet, 2001; Abu-Rustum NR, Gynecol Oncol, 2003

Port-

site m

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Minimize tissue trauma and the number of instrument transfers

Rinse trocars in 5% povidine-iodine before insertion

Perform trocar fixation

Rinse tip of instruments in 5% povidine-iodine when interchanging instruments

Resect tumor with adequate margins

Use protective bags to retrieve tumor

Remove all intraabdominal fluid before trocar removal

Deflate the abdomen with trocars in place

Irrigate site of trocars with 5% povidine-iodine

Close peritoneal trocar sites (10- to 12-mm trocars)

Preventive measures for reduction of port-site metastases

Effects of CO2 pneumoperitoneum

There have been limited human studies evaluating this effect.

The accuracy and adequacy of laparoscopic

surgical staging were comparable to laparotomic

approach, and the surgical outcomes were more

favorable than laparotomic approach. However,

the oncologic safety of laparoscopic

staging was not certain.

Surgical approach to adnexal masses

Low intermediate high

Laparoscopicsurgery

diagnosticlaparoscopy

laparotomy

laparoscopicsurgery

Laparotomy

Malignancy risk with USG and others