Laparoscopic techniques for extracting ovarian teratomas.

We performed two techniques for laparoscopic extraction of benign ovarian teratomas. For cysts up to 5 cm, we used the pouch technique, with partial extraction followed by enlargement of the hypogastric port. A skin incision was enlarged to allow the use of a scalpel in the pouch. This enabled us to perform several stab incisions in the cyst to spill its contents while still holding it in the pouch. This was followed by suction irrigation and forceps removal of the contents until the collapsed cyst could be removed in the pouch. For a cyst over 5 cm, we performed endoscopic aspiration irrigation with hot water inside the cyst, followed by partial extraction of the cyst; an opening was made in the exposed cyst wall and the contents extracted as described. When the cyst wall collapsed, we proceeded with the final extraction. When spillage occurred, it was managed with extensive warm lavage of the peritoneum, skimming the floating debris with suction tubing until clear, and underwater inspection and removal of teeth and other solid material. With these techniques, we experienced no complications.