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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.
Adn
eksi
yal k
itlel
erin
mor
folo
jik s
ınıf
land
ırılm
ası
ve
mal
igni
te r
iski
(IO
TA
)
Tim
mer
man
D, V
alen
tin L
, Bou
rne
TH
, Col
lins
WP
, Ver
rels
t H, V
ergo
te I,
In
tern
atio
nal O
varia
n T
umor
Ana
lysi
s (I
OT
A)
Gro
up: T
erm
s, d
efin
ition
s an
d m
easu
rem
ents
to d
escr
ibe
the
sono
grap
hic
feat
ures
of a
dnex
altu
mor
s: a
con
sens
us o
pini
on fr
om th
e In
tern
atio
nal O
varia
n T
umor
Ana
lysi
s (I
OT
A)G
roup
. Ultr
asou
nd O
bste
t Gyn
ecol
200
0; 1
6:50
0–50
5.
papillary projections
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
etasta
ses
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