Skip to main content

Ovarian Cysts: Preoperative Evaluation and Laparoscopic Approach

  • Chapter
  • First Online:
Minimally Invasive Gynecology

Abstract

Benign ovarian tumors remain a common gynecologic problem. The main goal of the preoperative work-up is to exclude malignancy. Laparoscopic approach is the gold standard for the management of ovarian masses because it is safe and has proven advantages compared with laparotomy. However, systematization of the procedure is essential! Oncologic surgical principles must be always followed even in those women whose mass has low suspicion for malignancy. The surgical technique must be adapted to the characteristics of the cyst and the patient. Experts should try to teach young surgeons the proper surgical technique in order to make it easier and reproducible.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. National Institutes of Health Consensus Development Conference Statement. Ovarian cancer: screening, treatment, and follow-up. Gynecol Oncol. 1994;55(3 Pt 2):S4–14.

    Google Scholar 

  2. NIH consensus conference. Ovarian cancer. Screening, treatment, and follow-up. NIH consensus development panel on ovarian cancer. JAMA. 1995;273(6):491–7.

    Google Scholar 

  3. Padilla LA, Radosevich DM, Milad MP. Accuracy of the pelvic examination in detecting adnexal masses. Obstet Gynecol. 2000;96(4):593–8.

    CAS  PubMed  Google Scholar 

  4. Hilger WS, Magrina JF, Magtibay PM. Laparoscopic management of the adnexal mass. Clin Obstet Gynecol. 2006;49(3):535–48.

    PubMed  Google Scholar 

  5. Canis M, Rabischong B, Houlle C, Botchorishvili R, Jardon K, Safi A, Wattiez A, Mage G, Pouly JL, Bruhat MA. Laparoscopic management of adnexal masses: a gold standard? Curr Opin Obstet Gynecol. 2002;14(4):423–8.

    PubMed  Google Scholar 

  6. Mais V, Ajossa S, Piras B, Marongiu D, Guerriero S, Melis GB. Treatment of nonendometriotic benign adnexal cysts: a randomized comparison of laparoscopy and laparotomy. Obstet Gynecol. 1995;86(5):770–4.

    CAS  PubMed  Google Scholar 

  7. Yuen PM, Yu KM, Yip SK, Lau WC, Rogers MS, Chang A. A randomized prospective study of laparoscopy and laparotomy in the management of benign ovarian masses. Am J Obstet Gynecol. 1997;177(1):109–14.

    CAS  PubMed  Google Scholar 

  8. Canis M, Mage G, Pouly JL, Wattiez A, Manhes H, Bruhat MA. Laparoscopic diagnosis of adnexal cystic masses: a 12-year experience with long-term follow-up. Obstet Gynecol. 1994;83(5 Pt 1):707–12.

    CAS  PubMed  Google Scholar 

  9. Sisodia RM, Del Carmen MG, Boruta DM. Role of minimally invasive surgery in the management of adnexal masses. Clin Obstet Gynecol. 2015;58(1):66–75.

    PubMed  Google Scholar 

  10. Earle CC, Schrag D, Neville BA, Yabroff KR, Topor M, Fahey A, Trimble EL, Bodurka DC, Bristow RE, Carney M, Warren JL. Effect of surgeon specialty on processes of care and outcomes for ovarian cancer patients. J Natl Cancer Inst. 2006;98(3):172–80.

    PubMed  Google Scholar 

  11. Boll D, Geomini PM, Brölmann HA, Sijmons EA, Heintz PM, Mol BW. The pre-operative assessment of the adnexal mass: the accuracy of clinical estimates versus clinical prediction rules. BJOG. 2003;110(5):519–23.

    PubMed  Google Scholar 

  12. Mol BW, Boll D, De Kanter M, Heintz AP, Sijmons EA, Oei SG, Bal H, Brölmann HA. Distinguishing the benign and malignant adnexal mass: an external validation of prognostic models. Gynecol Oncol. 2001;80(2):162–7.

    CAS  PubMed  Google Scholar 

  13. Bouic-Pagès E, Perrochia H, Mérigeaud S, Giacalone PY, Taourel P. MR imaging of primary ovarian tumors with pathologic correlation. J Radiol. 2009;90(7–8 Pt 1):787–802.

    PubMed  Google Scholar 

  14. Van Calster B, Valentin L, Van Holsbeke C, Testa AC, Bourne T, Van Huffel S, Timmerman D. Polytomous diagnosis of ovarian tumors as benign, borderline, primary invasive or metastatic: development and validation of standard and kernel-based risk prediction models. BMC Med Res Methodol. 2010;10:96. https://doi.org/10.1186/1471-2288-10-96.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Van Calster B, Van Hoorde K, Valentin L, Testa AC, Fischerova D, Van Holsbeke C, Savelli L, Franchi D, Epstein E, Kaijser J, Van Belle V, Czekierdowski A, Guerriero S, Fruscio R, Lanzani C, Scala F, Bourne T, Timmerman D, International Ovarian Tumour Analysis Group. Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicentre diagnostic study. BMJ. 2014;349:g5920. https://doi.org/10.1136/bmj.g5920.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Yancik R, Ries LG, Yates JW. Ovarian cancer in the elderly: an analysis of surveillance, epidemiology, and end results program data. Am J Obstet Gynecol. 1986;154(3):639–47.

    CAS  PubMed  Google Scholar 

  17. Perera DS, Prabhakar HB. Imaging of the adnexal mass. Clin Obstet Gynecol. 2015;58(1):28–46.

    PubMed  Google Scholar 

  18. Schneider VL, Schneider A, Reed KL, Hatch KD. Comparison of Doppler with two-dimensional sonography and CA 125 for prediction of malignancy of pelvic masses. Obstet Gynecol. 1993;81(6):983–8.

    CAS  PubMed  Google Scholar 

  19. Timor-Tritsch LE, Lerner JP, Monteagudo A, Santos R. Transvaginal ultrasonographic characterization of ovarian masses by means of color flow-directed Doppler measurements and a morphologic scoring system. Am J Obstet Gynecol. 1993;168(3 Pt 1):909–13.

    CAS  PubMed  Google Scholar 

  20. Weiner Z, Beck D, Shteiner M, Borovik R, Ben-Shachar M, Robinzon E, Brandes JM. Screening for ovarian cancer in women with breast cancer with transvaginal sonography and color flow imaging. J Ultrasound Med. 1993;12(7):387–93.

    CAS  PubMed  Google Scholar 

  21. Jeong YY, Outwater EK, Kang HK. Imaging evaluation of ovarian masses. Radiographics. 2000;20(5):1445–70.

    CAS  PubMed  Google Scholar 

  22. Kondo W, Zomer MT, Pinto EP, Ribeiro R, Ribeiro MFC, Trippia CR, Trippia CH. Deep infiltrating endometriosis: imaging features and laparoscopic correlation. J Endometr. 2011;3(4):197–212.

    Google Scholar 

  23. Trippia CH, Zomer MT, Terazaki CRT, Martin RLS, Ribeiro R, Kondo W. Relevance of imaging examinations in the surgical planning of patients with bowel endometriosis. Clin Med Insights Reprod Health. 2016;10:1–8.

    PubMed  PubMed Central  Google Scholar 

  24. Bast RC Jr, Klug TL, St John E, Jenison E, Niloff JM, Lazarus H, Berkowitz RS, Leavitt T, Griffiths CT, Parker L, Zurawski VR Jr, Knapp RC. A radioimmunoassay using a monoclonal antibody to monitor the course of epithelial ovarian cancer. N Engl J Med. 1983;309(15):883–7.

    PubMed  Google Scholar 

  25. Sölétormos G, Duffy MJ, Othman Abu Hassan S, Verheijen RH, Tholander B, Bast RC Jr, Gaarenstroom KN, Sturgeon CM, Bonfrer JM, Petersen PH, Troonen H, CarloTorre G, Kanty Kulpa J, Tuxen MK, Molina R. Clinical use of cancer biomarkers in epithelial ovarian cancer: updated guidelines from the European Group on Tumor Markers. Int J Gynecol Cancer. 2016;26(1):43–51.

    PubMed  Google Scholar 

  26. Duffy MJ, Bonfrer JM, Kulpa J, Rustin GJ, Soletormos G, Torre GC, Tuxen MK, Zwirner M. CA125 in ovarian cancer: European Group on Tumor Markers guidelines for clinical use. Int J Gynecol Cancer. 2005;15(5):679–91.

    CAS  PubMed  Google Scholar 

  27. Liu J, Matulonis UA. Anti-angiogenic agents in ovarian cancer: dawn of a new era? Curr Oncol Rep. 2011;13(6):450–8.

    CAS  PubMed  Google Scholar 

  28. Høgdall EV, Christensen L, Kjaer SK, Blaakaer J, Jarle Christensen I, Gayther S, Jacobs IJ, Høgdall CK. Protein expression levels of carcinoembryonic antigen (CEA) in Danish ovarian cancer patients: from the Danish ‘MALOVA’ ovarian cancer study. Pathology. 2008;40(5):487–92.

    PubMed  Google Scholar 

  29. Kelly PJ, Archbold P, Price JH, Cardwell C, McCluggage WG. Serum CA19.9 levels are commonly elevated in primary ovarian mucinous tumours but cannot be used to predict the histological subtype. J Clin Pathol. 2010;63(2):169–73.

    CAS  PubMed  Google Scholar 

  30. National Institute for Health and Clinical Excellence. Ovarian cancer: the recognition and initial management of ovarian cancer. NICE clinical guideline 122. London: NICE; 2011.

    Google Scholar 

  31. American College of Obstetricians and Gynecologists. Management of adnexal masses. ACOG Practice Bulletin No. 83. Washington DC: ACOG; 2007.

    Google Scholar 

  32. Goodman LR, Goldberg JM, Flyckt RL, Gupta M, Harwalker MJ, Falcone T. Effect of surgery on ovarian reserve in women with endometriomas, endometriosis and controls. Am J Obstet Gynecol. 2016;215(5):589.e1–6.

    PubMed  Google Scholar 

  33. Kondo W, Bourdel N, Cotte B, Tran X, Botchorishvili R, Jardon K, Rabischong B, Pouly JL, Mage G, Canis M. Does prevention of intraperitoneal spillage when removing a dermoid cyst prevent granulomatous peritonitis? BJOG. 2010;117(8):1027–30.

    CAS  PubMed  Google Scholar 

  34. Bristow RE, Berek JS. Surgery for ovarian cancer: how to improve survival. Lancet. 2006;367(9522):1558–60.

    PubMed  Google Scholar 

  35. Bristow RE, Nugent AC, Zahurak ML, Khouzhami V, Fox HE. Impact of surgeon specialty on ovarian-conserving surgery in young females with an adnexal mass. J Adolesc Health. 2006;39(3):411–6.

    PubMed  Google Scholar 

  36. Canis M, Jardon K, Rabischong B, Bourdel N, Mage G. Advanced ovarian cancer, an optimal surgical treatment is possible to all patients owing to laparoscopy. Ann Chir. 2006;131(8):423–5.

    CAS  PubMed  Google Scholar 

  37. Canis M, Pouly JL, Wattiez A, Mage G, Manhes H, Bruhat MA. Laparoscopic management of adnexal masses suspicious at ultrasound. Obstet Gynecol. 1997;89(5 Pt 1):679–83.

    CAS  PubMed  Google Scholar 

  38. Hidlebaugh DA, Vulgaropulos S, Orr RK. Treating adnexal masses. Operative laparoscopy vs. laparotomy. J Reprod Med. 1997;42(9):551–8.

    CAS  PubMed  Google Scholar 

  39. Pittaway DE, Takacs P, Bauguess P. Laparoscopic adnexectomy: a comparison with laparotomy. Am J Obstet Gynecol. 1994;171(2):385–9; discussion 389–91.

    CAS  PubMed  Google Scholar 

  40. Delabaere A, Bourdel N, Botchorishvili R, Tran X, Jardon K, Rabischong B, Canis M, Mage G. How I do... laparoscopy with previous laparotomy. Gynecol Obstet Fertil. 2009;37(4):346–8.

    CAS  PubMed  Google Scholar 

  41. Dubuisson J, Botchorishvili R, Perrette S, Bourdel N, Jardon K, Rabischong B, Canis M, Mage G. Incidence of intraabdominal adhesions in a continuous series of 1000 laparoscopic procedures. Am J Obstet Gynecol. 2010;203(2):111.e1–3.

    PubMed  Google Scholar 

  42. Canis M, Jardon K, Niro J, Rabischong B, Bourdel N, Botchorishvili R, Pouly JL, Mage G. Endoscopic management of gynecological malignancies: an update. 2007. Bull Acad Natl Med. 2007;191(7):1357–65; discussion 1365–6.

    PubMed  Google Scholar 

  43. Possover M, Morawski A, Hettenbach A. Laparoscopic treatment of ovarian tumors in menopausal women. J Gynecol Obstet Biol Reprod (Paris). 1994;23(7):784–9.

    CAS  PubMed  Google Scholar 

  44. Possover M, Mader M, Zielinski J, Pietrzak K, Hettenbach A. Is laparotomy for staging early ovarian cancer an absolute necessity? J Am Assoc Gynecol Laparosc. 1995;2(3):285–8.

    CAS  PubMed  Google Scholar 

  45. Chéreau E, Ballester M, Rouzier R, Coutant C, Daraï E. Advanced ovarian cancer: criteria of resectability. Bull Cancer. 2009;96(12):1189–97. https://doi.org/10.1684/bdc.2009.0985.

    Article  PubMed  Google Scholar 

  46. Fagotti A, Ferrandina G, Fanfani F, Ercoli A, Lorusso D, Rossi M, Scambia G. A laparoscopy-based score to predict surgical outcome in patients with advanced ovarian carcinoma: a pilot study. Ann Surg Oncol. 2006;13(8):1156–61.

    PubMed  Google Scholar 

  47. Mage G, Canis M, Manhes H, Pouly JL, Bruhat MA. Ovarian cysts and celioscopy. Apropos 226 cases. J Gynecol Obstet Biol Reprod (Paris). 1987;16(8):1053–61.

    CAS  PubMed  Google Scholar 

  48. Blanc B, D’Ercole C, Nicoloso E, Boubli L. Laparoscopic management of malignant ovarian cysts: a 78-case national survey. Part 2: follow-up and final treatment. Eur J Obstet Gynecol Reprod Biol. 1995;61(2):147–50.

    CAS  PubMed  Google Scholar 

  49. Zomer MT, Ribeiro R, Branco AW, Branco Filho AJ, Kondo W. How do I treat ovarian dermoid cyst by laparoscopy? Bras J Video-Surg. 2011;4(2):84–90.

    Google Scholar 

  50. Kondo W, Bourdel N, Zomer MT, Slim K, Rabischong B, Pouly JL, Mage G, Canis M. Laparoscopic cystectomy for ovarian endometrioma—a simple stripping technique should not be used. J Endometr. 2011;3(3):125–34.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kondo, W., Zomer, M.T., Bourdel, N., Canis, M. (2018). Ovarian Cysts: Preoperative Evaluation and Laparoscopic Approach. In: Gomes-da-Silveira, G.G., da Silveira, G.P.G., Pessini, S.A. (eds) Minimally Invasive Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-319-72592-5_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-72592-5_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-72591-8

  • Online ISBN: 978-3-319-72592-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics