A Self-Made Bag-Assisted Laparoendoscopic Single-Site Surgery in Ovarian Teratomectomy during Pregnancy.

OBJECTIVE

The objective is to demonstrate stepwise self-made bag technique and surgical technique in managing ovarian dermoid cystectomy in pregnant patients through laparoendoscopic single-site surgery (LESS). The reported incidence of ovarian cysts in pregnancy varies from 0.05% to 1.2%; compared with open surgery, laparoscopic surgery adnexal cyst during pregnancy does not increase the risk to mother and fetus.[12] In addition, LESS has better postoperative recovery. However, conventional laparoscopic surgery is safer than LESS.[3]

DESIGN

Stepwise demonstration of the technique with narrated video footage.

INTERVENTIONS

The patient was a 31-year-old woman, gravida 3, para 2, at a gestational age of 15 weeks, who was diagnosed with 5.6 cm × 4.1 cm right ovarian teratoma and 2.0 cm × 2.3 cm left ovarian cyst. Ovarian teratomectomy was performed at the same time of the previous cesarean section in 2018. A self-made bag-assisted LESS approach to ovarian teratoma with several key strategies to minimize fetal impact, ovarian damage, and blood loss [Video 1]:

Make a retrieval bag [Figure 1]before surgery with an inner packaging bag of the disposable suction tube

Figure 1

Make a retrieval bag before surgery by suturing around one side of the inner packaging bag of suction tube http://www.apagemit.com/page/video/show.aspx?num=292&kind=2&page=1

Place the affected ovary in the retrieval bag and pull the bottom of the retrieval bag to the umbilicus to reduce the stimulation of the uterus by surgical procedures [Figure 2]

Figure 2

Pull the bottom of the retrieval bag to the umbilicus to reduce the stimulation of the uterus

Cut the surface of the affected ovary with a cold blade to reduce ovarian damage [Figure 3]

Figure 3

Suture the ovary for hemostasis and shaping

Dissect the teratoma pedicle with an ultrasonic knife to reduce bleeding.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

CONCLUSION

When performing an ovarian cystectomy under LESS, we could use an upside down specimen bag to conveniently remove the cyst from the abdominal cavity with no spillage of toxic dermoid contents. A self-made specimen bag is cost-saving and convenient to use. The operation has the least impact on the pregnant uterus and avoids the impact on the fetus. Availability of a cold knife and hand suturing can maximize ovarian tissue preservation, leading to better protection of ovarian function.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.