Management of presumed benign giant ovarian cysts: a minimally invasive technique using the Alexis Laparoscopic System.

STUDY

OBJECTIVE

To evaluate a minimally invasive surgical technique for the treatment of presumed benign giant cysts using the Alexis Laparoscopic System (Applied Medical, Rancho Santa Margarita, CA), which includes a wound protector/retractor and a laparoscopic "cap."

DESIGN

Step-by-step explanation of the procedure using videos.

SETTING

The incidence of presumed benign giant ovarian cysts is rare. The standard surgical treatment traditionally requires gaining access by a midline laparotomy to facilitate retrieval of the resected specimen and minimize the risk of cyst spillage. Various minimally invasive techniques (ultrasound-guided or laparoscopic-guided intracystic aspiration methods) have been described in the last few decades to reduce morbidity associated with open surgery. Nonetheless, these techniques are poorly standardized and have not seen widespread use. They have been shown to be fairly technically complex to perform, and are sometimes unreliable in cases of unexpected malignancy.

INTERVENTIONS: We propose a standardization of the minimally invasive surgical treatment of presumed benign giant ovarian cysts using the Alexis Laparoscopic System. We were driven by the advantages provided by the Alexis wound protector/retractor used in other surgical disciplines. This device allows for better surgical exposure and oncologic safety. The preoperative criteria for selection are very strict, to minimize the risk of unexpected malignancy.

CONCLUSION

The use of the Alexis Laparoscopic System for the surgical management of presumed benign giant ovarian cysts offers excellent exposure and control, representing a safe alternative over other minimally invasive surgical procedures. This reproducible technique allows for reduced risk of intestinal or vascular injury by avoiding blind punctures; reduced risk of parietal tumoral seeding with use of the wound protector; reduced risk of intra-abdominal cyst spillage due to appropriate surgical exposure with the wound retractor, which allows tight closure of the puncture site; the possibility of converting the open surgery access into a standard laparoscopy using a laparoscopic "cap" that maintains pneumoperitoneum without tricks.