Laparoscopic 'oophorectomy-in-a bag'--an alternative to laparotomy for the evaluation of suspicious ovarian masses.

A prospective observational study was performed to assess the feasibility of the technique of laparoscopic 'oophorectomy-ina bag' for the safe removal of ovarian masses that do not meet the standard guidelines for laparoscopic management of adnexal pathology. Ovarian lesions were selected preoperatively by: age of the patient, ultrasound appearance, bilaterality and size. None of the women had ascites or matted bowel on ultrasound, and all had normal serum tumour markers. There were no stigmata of malignant disease in any of the cases at the time of surgery. Twenty women were recruited. Eighteen procedures (90.0%) were completed successfully laparoscopically. In two cases the bag could not be removed laparoscopically and minilaparotomy was performed. Nineteen of the tumours (95.0%) were removed without intra-abdominal spillage; the bag ruptured in one case. There were no major complications. One case of borderline ovarian tumour (stage Ia) was discovered. We conclude that laparoscopic 'oophorectomy-in-a bag' allows for the safe removal of suspicious ovarian tumours. The advantages of this approach are that women can be treated locally, a laparotomy is avoided, and the subgroup with ovarian malignancy can be identified to be referred to an oncological centre.