Dermoid tumors of the ovary: evaluation of the gasless lift-laparoscopic approach.

Laparoscopic removal is widely accepted as the treatment of choice for dermoid tumors. However, the spillage of dermoid content with the laparoscopic approach is very high compared to laparotomy. The potential malignancy of dermoid tumors and the rare, but difficult to treat, chemical peritonitis in cases of spillage of dermoid content should lead to an adaptation of procedures during an endoscopic operation on a dermoid tumor to comply with the precautions of the "open" technique. Lift-laparoscopy combines laparoscopy with the standard procedures of laparotomy and thus may help reduce the spillage of dermoid contents. In a retrospective study of 108 patients with dermoid tumors, the frequency of the rupture of a dermoid tumor during a lift-laparoscopic operation was examined. Among the 79 cases of organ-preserving treatment, there were only three cases (3.8%) where a rupture of the dermoid capsule occurred. Even in cases of ruptures, it was possible to avoid spillage by closing the lesion with a clamp and continue the enucleation of the dermoid tumor during a lift-laparascopic operation. After thorough abdominal cavity lavage, none of these three cases showed a cytological contamination of the abdominal cavity with dermoid cells. None of the ovariectomy or adnexectomy cases showed a rupture. Histologically, there was also no carcinoma in any of the examined dermoid tumors. By adapting the endoscopic dermoid surgery to the precautions established in an open surgery technique using gasless lift-laparoscopy, ruptures and cell spilling can be avoided to a large extent but not completely excluded. Compared with other methods, the number of ruptures and spillage of dermoids by organ-preserving treatment as well as ovariectomy is lowest using a lift-laparoscopic procedure.