婦人科腫瘍学の現在の動向

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Laparoscopic Surgery for Large Ovarian Cysts- Review

Gamal Eltabbakh

Introduction: Laparoscopic surgery has been increasingly applied to different gynecologic problems with excellent surgical outcome and rapid recovery. Large ovarian cysts, a relatively common gynecologic problem, pose certain challenges to laparoscopic management.

Objective: The aim of the present study was to review published reports on laparoscopic surgery for large ovarian cysts and summarize their findings regarding patients’ selection, surgical outcome, technical methods and the final pathology report.

Methods: A review of the English language literature of the MEDLINE (PubMed) database was performed using the key words: ovarian cysts, laparoscopy, large, huge and robotic. An additional collection of reports was found by systematically reviewing all references from retrieved papers. The review was limited to case reports including 5 or more patients and excluded laparoscopic surgery for ovarian cysts in pregnancy.

Results: A total of 20 studies including 852 patients were identified. There was one prospective randomized study. The operative and postoperative complication rates were 1.9% and 3.9% of the cases were converted to laparotomy. Borderline ovarian tumors and ovarian cancers were identified in 2.5% and 3.1% of the patients, respectively. The incidence of borderline tumors and ovarian cancer varied depending on the selection criteria used for management of women with large ovarian cysts laparoscopically. Criteria for patients’ selection and surgical techniques employed to reduce tumor spill and extract the large cysts are reviewed.

Conclusions: Laparoscopy is a safe technique for managing patients with large ovarian cysts and is associated with low conversion and complication rates. The chance of finding unexpected ovarian cancer varies according to the patients’ selection criteria but is low overall.