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Cureus Sep 2022Ovarian cysts are usually asymptomatic and self-resolvable, but large cysts can increase the risk of ovarian torsion or rupture and may be indicated for surgical...
Ovarian cysts are usually asymptomatic and self-resolvable, but large cysts can increase the risk of ovarian torsion or rupture and may be indicated for surgical intervention. We present the case of a large left ovarian cyst in which laparoscopic left salpingo-oophorectomy was challenged by an overlying sigmoid colon with dense adhesions. A 47-year-old female patient presented to the emergency department with abdominal pain in the right lower quadrant. Ultrasound and computed tomography scans found a large left ovarian cyst and multiple small right ovarian cysts. Due to the size of the left ovarian cyst increasing the risk for torsion, the patient was indicated for laparoscopic left salpingo-oophorectomy. However, the cyst was inaccessible due to the overlying sigmoid colon and dense adhesions on all sides. The surgeons elected to drain the cyst, and the patient was counseled that it was safe to monitor for postoperative recurrence over the next three months. Though laparoscopic surgery is considered a gold standard modality for minimally-invasive ovarian cystectomy/oophorectomy, our case illustrates how it can be challenging when treating left-sided adnexal masses in post-hysterectomy patients due to rectosigmoid and adhesional obstruction. In the context of this challenge, our case further demonstrates the importance of preoperative ovarian cancer screening and favoring conservative treatment options whenever possible.
PubMed: 36237789
DOI: 10.7759/cureus.28927 -
European Review For Medical and... Jun 2023To preserve ovarian reserve, we treated ovarian endometriomas by ultrasound-guided aspiration followed by sclerotherapy of the cyst mucosa. We compared the results with...
OBJECTIVE
To preserve ovarian reserve, we treated ovarian endometriomas by ultrasound-guided aspiration followed by sclerotherapy of the cyst mucosa. We compared the results with laparoscopic cystectomy.
PATIENTS AND METHODS
We conducted a retrospective study of 96 women with ovarian endometriomas. In 54 of the women, ultrasound-guided aspiration of the contents was performed, followed by chemical sclerotherapy of the cyst plaque with ethanol. Laparoscopic cystectomy was performed in the remaining 42 women.
RESULTS
Statistical analysis of anti-Mullerian hormone (AMH) levels before and after the procedures showed a significant decrease in the case of cystectomy compared with ethanolic ovarian sclerotherapy (EOS).
CONCLUSIONS
Conservative treatment by echo-assisted puncture and sclerotherapy with ethanol proved to be a viable treatment for the removal of ovarian endometriomas. It is a simple procedure that does not affect ovarian reserve or fertility.
Topics: Female; Humans; Endometriosis; Ovarian Reserve; Sclerotherapy; Retrospective Studies; Cysts; Laparoscopy; Ethanol; Ovarian Cysts
PubMed: 37401294
DOI: 10.26355/eurrev_202306_32795 -
Journal of Nepal Health Research Council Mar 2022A 32-year-old unmarried female on an atypical antipsychotic presented with massive abdominal distension and progressive difficulty in breathing and ambulation. Imaging...
A 32-year-old unmarried female on an atypical antipsychotic presented with massive abdominal distension and progressive difficulty in breathing and ambulation. Imaging revealed a giant ovarian mass originating on the right side. A fertility sparing laparotomy was carried out, without complication. Histopathological evaluation revealed a seromucinous cystadenoma. Giant ovarian cysts are seldom encountered in current medical practice secondary to easy availability of imaging modalities and treatment facilities. In spite of their considerable size, such tumors are usually benign and have a good prognosis. Keywords: Fertility sparing laparotomy; giant ovarian cysts; Seromucinous cystadenomas.
Topics: Adult; Female; Humans; Nepal; Ovarian Cysts
PubMed: 35615849
DOI: 10.33314/jnhrc.v19i04.3851 -
Obstetrics and Gynecology Dec 2023To estimate surveillance intervals of incident ovarian cysts, and describe variables associated with cyst resolution times. (Clinical Trial)
Clinical Trial
OBJECTIVE
To estimate surveillance intervals of incident ovarian cysts, and describe variables associated with cyst resolution times.
METHODS
The UK-OCST (University of Kentucky Ovarian Cancer Screening Trial) was a prospective cohort that enrolled 47,762 individuals over 30 years, including 2,638 individuals with incident cysts. Cyst diameter and structure and patient age, body mass index, use of hormone therapy (HT), family history of ovarian cancer, and menopausal status were examined as variables associated with cyst resolution using t tests, χ 2 test, Kaplan Meier, and Cox multiple regression.
RESULTS
Of 2,638 individuals with incident cysts, 1,667 experienced resolution (63.2%) within 1.2 years, and 971 experienced persistence (36.8%). Within 1 year, unilocular and septated cysts had similar resolution rates (35.4% and 36.7%, respectively, P >.05), but time to resolution was shorter for unilocular cysts compared with septated cysts (mean 1.89 years vs 2.58 years, respectively, P <.001). Both unilocular and septated cysts smaller than 3 cm resolved faster than cysts larger than 6 cm ( P <.001). Variables associated with percent resolution included being of younger age, premenopausal status (but not for synchronous bilateral cysts), and those reporting a family history of ovarian cancer ( P <.05). Variables associated with a faster cyst resolution rate included being older than age 70 years and not using hormone therapy. Body mass index and family history were not associated with cyst resolution time.
CONCLUSION
Different surveillance times may be appropriate depending on cyst structure and size and patient age and HT use.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov , NCT04473833.
Topics: Adult; Aged; Female; Humans; Middle Aged; Cysts; Hormones; Ovarian Cysts; Ovarian Neoplasms; Prospective Studies; Ultrasonography
PubMed: 38051292
DOI: 10.1097/AOG.0000000000005411 -
The American Journal of Case Reports Nov 2021BACKGROUND Adnexal torsion is a gynecologic emergency that dictates immediate surgical intervention. Twisted ovarian cysts are rare in adolescents, but they can cause... (Review)
Review
BACKGROUND Adnexal torsion is a gynecologic emergency that dictates immediate surgical intervention. Twisted ovarian cysts are rare in adolescents, but they can cause significant distress to patients. Idiopathic ovarian torsion is uncommon in adolescents and the incidence is reportedly higher in women aged 20 to 40 years. Most twisted cysts in adolescents are benign. In the past, oophorectomy was commonly performed for a torsed ovary, but currently there is a trend toward ovary preservation. The diagnosis of twisted ovarian cyst is based on pathognomonic symptoms and findings from a focused clinical examination and ultrasound. Because the differential diagnosis includes acute appendicitis and gastroenteritis, referral to a gynecologist may be delayed. CASE REPORT We present the case of a huge, twisted ovarian cyst in a 16-year-old girl who presented with an acute abdomen. The initial diagnosis was acute appendicitis, which delayed her referral to a gynecologist. An emergency laparotomy and left salpingo-oophorectomy were performed. The histopathology of the ovarian cyst was reported as serous cystadenoma. CONCLUSIONS The optimal management of a twisted ovarian cyst in adolescents is the subject of much debate. Here, we review the literature on ovarian torsion in children and adolescents. The patient in the case we present had a twisted ovarian cyst that was managed with salpingo-oophorectomy.
Topics: Adolescent; Child; Female; Humans; Ovarian Cysts; Ovarian Torsion; Ovariectomy; Salpingo-oophorectomy; Torsion Abnormality
PubMed: 34785630
DOI: 10.12659/AJCR.933438 -
Cureus Mar 2022Aim The aim of this study is to investigate the quality and reliability of YouTube videos containing content related to ovarian cysts. Methods The search terms "Ovarian...
Aim The aim of this study is to investigate the quality and reliability of YouTube videos containing content related to ovarian cysts. Methods The search terms "Ovarian Cyst", "Ovarian Cyst Symptoms", "Ovarian Cyst Treatment", and "Ovarian Cyst Diagnosis" were searched on YouTube. A total of 110 videos were examined and repetitive videos, non-English videos, videos with advertising content, videos with entertainment and news content, and videos with very poor image and sound quality were excluded. Finally, the videos included in the study were evaluated using DISCERN and Global Quality Scale (GQS). Results It was found that 50 videos examined in this study were uploaded between the years 2014 and 2020, with an average of 492.252 ± 710.768 and a total of 24.612.595 views. The mean DISCERN score given to 50 videos analyzed by two researchers was 2.81 ± 1.3 and the mean GQS score was 2.88 ± 1.4. When we divided the scores given to the videos by two researchers into three groups, it was determined that 27 (54%) of the 50 videos were in the misleading/poor quality group, nine (18%) were in the medium quality group, and 14 (28%) were in the useful/quality group. Conclusion It has been determined that the videos with "ovarian cyst" content on YouTube are generally of poor quality. Bad quality videos were uploaded by non-doctors and attracted more attention than videos uploaded by doctors.
PubMed: 35386475
DOI: 10.7759/cureus.22739 -
BMC Pregnancy and Childbirth Apr 2021A uterine manipulator cannot be used to elevate the ovary in benign ovarian surgery during pregnancy. This report describes our method of elevation of the ovary using a...
BACKGROUND
A uterine manipulator cannot be used to elevate the ovary in benign ovarian surgery during pregnancy. This report describes our method of elevation of the ovary using a metreurynter with the success rate of the procedure and a comparison of surgical results and pregnancy outcomes between the successful and unsuccessful cases.
METHODS
Between August 2003 and February 2020, 11 pregnant patients with a tumor found sunk in the Cul-de-sac underwent laparoscopic cystectomy for a benign ovarian cyst with a metreurynter. The surgical results, success and failure of the elevation by a metreurynter, pregnancy outcomes, and fetal status at delivery were evaluated.
RESULTS
Elevation of ovarian tumors with a metreurynter was successful in nine cases. However, it was unsuccessful in the remaining two cases wherein the ovary was lifted with forceps while the uterus was in a compressed state. The operative time was also longer in these cases. The pregnancy prognosis, however, was good for both, successful and unsuccessful cases.
CONCLUSIONS
The metreurynter is an inexpensive and practical obstetric device, and its optimal use allows the performance of a procedure with minimal burden on a pregnant uterus. Therefore, we recommend the appropriate use of this method to enable effective laparoscopic cystectomy of ovarian tumors during pregnancy.
Topics: Adult; Douglas' Pouch; Female; Humans; Intraoperative Complications; Laparoscopy; Lifting; Operative Time; Ovarian Cysts; Ovariectomy; Pneumoperitoneum, Artificial; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Surgical Instruments; Uterus
PubMed: 33892651
DOI: 10.1186/s12884-021-03774-w -
International Journal of Gynaecology... May 2024The aim of this study was to evaluate the impact of having an ovarian cyst and undergoing cystectomy on the expression of ovarian reserve markers among adolescent...
OBJECTIVE
The aim of this study was to evaluate the impact of having an ovarian cyst and undergoing cystectomy on the expression of ovarian reserve markers among adolescent females who live in Armenia.
METHODS
We conducted a prospective case-control study. Cases were arranged into two groups. The postoperative group (POG) included those who underwent unilateral ovarian cystectomy, and those in the benign ovarian cyst group (BOCG) had complex ovarian cysts with a diameter of 5 cm or more. Adolescents without ovarian pathologies were included in the reference group (RFG). Levels of anti-Mullerian hormone (AMH) and follicular stimulating hormone (FSH) were measured, and an ultrasound investigation of antral follicular count (AFC) was also done.
RESULTS
Mean differences between baseline and 6-month follow-up levels of AMH, AFC significantly decreased in both the POG and BOCG compared to the RFG. However, the decrease was more significant in the POG: a decrease of 0.86 ng/mL for AMH and 3.11 ng/mL for AFC versus decreasing by 0.61 ng/mL for AMH and 1.68 ng/mL for AFC. Meanwhile, in the BOCG, 6-month FSH levels did not show any significant changes compared to the baseline measurement. In comparison with the reference group, there was a significant decrease in the levels of AMH and AFC among participants who had endometriomas and cystadenomas.
CONCLUSION
Benign ovarian cysts 5 cm or more in diameter, as well as cystectomy, statistically affect OR after 6 months. Therefore, adolescents with ovarian cyst or cystectomy need individualized support to maintain reproductive age fertility.
Topics: Female; Adolescent; Humans; Ovarian Reserve; Case-Control Studies; Ovarian Cysts; Fertility; Follicle Stimulating Hormone; Endometriosis; Anti-Mullerian Hormone; Laparoscopy
PubMed: 38059670
DOI: 10.1002/ijgo.15284 -
Journal of Minimally Invasive Gynecology Jul 2021
Topics: Dermoid Cyst; Fallopian Tubes; Female; Humans; Ovarian Cysts; Ovarian Neoplasms; Teratoma
PubMed: 32911089
DOI: 10.1016/j.jmig.2020.09.001 -
Journal of Minimally Invasive Gynecology Sep 2022In this video, we describe a 5-step surgical technique that allows us to safely incise and aspirate the content of large ovarian cysts through a single-port laparoscopic...
STUDY OBJECTIVE
In this video, we describe a 5-step surgical technique that allows us to safely incise and aspirate the content of large ovarian cysts through a single-port laparoscopic incision. This allows performing laparoscopic oophorectomies instead of large xipho-pubic laparotomies.
DESIGN
A stepwise demonstration of the technique with narrated video footage.
SETTING
Ovarian masses, especially cysts, are common gynecologic conditions [1]. However, depending on their size, large adnexal cysts are usually managed with transverse or midline laparotomies [2]. This is to prevent cyst ruptures and abdominal contamination and ensure oncological safety of the procedure [3-5]. Different leak-proof aspiration techniques have been described in the literature allowing for safe large cyst aspiration and adnexectomy through a mini-laparotomy incision or via laparoscopy [2,3,6-10]. We describe a 5-step surgical technique allowing for closed aspiration of ovarian intracystic fluid and adnexectomy while respecting oncological safety.
INTERVENTIONS
Step 1: Perform diagnostic laparoscopy to rule out peritoneal carcinomatosis contraindicating this procedure and then after cyst exposition, thoroughly dry the cyst wall. Step 1 Bis: Cut the cuff of a sterile glove to prepare a square piece of membrane. Step 2: Place a protective gauze and then apply the surgical glue to the ovarian cyst wall followed by the glove/membrane application. Perform a purse suture through the glove/membrane and the ovarian wall superficially to ensure further adhesion and prevent ovarian fluid spillage. Step 3: Incise the ovarian wall, introduce the aspiration cannula and tighten the purse suture to aspirate the cystic fluid. Step 4: After aspiration is complete, tighten the suture and close the glove to guarantee a closed space and prevent abdominal contamination. Step 5: Perform laparoscopic oophorectomy or cystectomy. Safely remove the specimen in an endoscopic retrieval bag through the trocar incision.
CONCLUSION
This technique allows safe laparoscopic large ovarian cysts resections while respecting oncologic safety and preventing intra-abdominal spillage and contamination.
Topics: Cysts; Female; Humans; Laparoscopy; Laparotomy; Ovarian Cysts; Ovariectomy
PubMed: 35753617
DOI: 10.1016/j.jmig.2022.06.018