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Laparoscopic single port treatment of a left ovarian dermoid cyst

Authors

Abstract

In this video we demonstrate the laparoscopic single-port treatment of a left ovarian dermoid cyst in a 40-year-old patient using the E.K. Glove port. Every effort is made to enucleate the cyst without perforation.

Classification

single port, contribution

Keywords

Laparoscopic single port treatment, left ovarian dermoid cyst

Media type

Duration

06'53''

Publication

2012-02

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E-publication

WeBSurg.com, Feb 2012;12(02).
URL: http://www.websurg.com/doi-vd01en3579.htm

Laparoscopic single port treatment of a left ovarian dermoid cyst

1. Case presentation 00'10''

We present the single-port laparoscopic treatment of a left ovarian dermoid cyst in a 40-year-old patient using the E.K. Glove port. She is a mother one child with the history of pain in the left lower abdomen for two months.

2. Inspection of the cyst 00'25''

After a proper diagnostic laparoscopy, the left ovarian cyst is inspected and subjected for surgery. The capsule of the ovary is free and there is no stigma of any malignancy.

3. Cauterization of the cyst surface 00'38''

Bipolar cautery is applied to the surface of the cyst this helps to minimise bleeding when a sharp incision is made on the ovarian capsule.

4. Beginning of dissection 00'51''

A Maryland grasper is introduced and a space is created between the cyst and the capsule. The two leaves of the capsule is then held with the graspers and separated with the aim to enucleate the cyst. All care is taken to be as gentle as possible and to enucleate the cyst without perforation. Small, short bursts of monopolar cautery are applied intermittently whenever necessary.

5. Use of conventional instruments and roticulators 01'27''

Conventional straight hand instruments and a roteculator are used to get a better access of the operative field. It is found that with the straight instruments sufficient traction and counter traction can be applied. But with the roteculators or curved instruments we get adequate triangulations but not sufficient force to separate the structures.

6. Sharp and blunt dissection 02'16''

Alternate sharp and blunt dissections are done to achieve our goal. If we are working in the correct plane of cleavage there is hardly any bleeding. The secret of a successful dissection without perforating the cyst depends on the knowledge, patience, perseverance, and determination of the surgeon.

7. Proper plane of cleavage 02'40''

We hold the capsule and keep on working to find a good plane of cleavage so that there is minimum bleeding and there is no spillage of the content of the cyst

8. Avoiding spillage 03'52''

It is imperative to avoid spillage in a dermoid cyst as the spillage could cause chemical peritonitis and also increases the operating time since we have to do a lot of suction and irrigation and lavage to clear up the pelvis if the hair, teeth, bones and fatty materials are spilled in the peritoneal cavity.

9. Safe enucleation of the cyst 04'41''

The cyst is carefully enucleated from the capsule by traction and counter traction. In some areas the cyst is tightly adherent to the capsule which requires sharp dissection. Every effort is made to minimize the excessive use of diathermy current.

10. Division of the final attachment 04'59''

The final attachments of the cyst to the ovary are divided with a pair of scissors.

11. Placement of specimen in plastic bag 05'54''

A plastic retrieval bag is introduced through the E.K. glove port and the specimen is introduced in to it.

12. Saline wash and extraction of the specimen 06'26''

Saline wash is given to the pelvis and the operative site is inspected for any sign of bleeding. The specimen is extracted through the E.K. Glove port in the umbilicus.

13. Conclusion 06'41''

The advantage of single-port cystectomy is that we do not have to enlarge the port neither do we have to do a colpotomy for the extraction of the specimen.

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