Safe and cost-effective laparoscopic removal of adnexal masses

Abstract Study Objective. To evaluate laparoscopic removal of adnexal masses using a plastic bag to avoid peritoneal spillage. Design. An observational study. Setting. A university-affiliated private hospital. Patients. Thirty-one women (mean age 48.7 yrs) with adnexal masses. Interventions. Laparoscopic removal of adnexal masses ranging from 3 to 12 cm (18 complex, 5 septated cystic masses, 8 persistent simple cysts). The masses were placed in plastic sandwich bag and removed through the umbilical incision Hospital costs, length of stay and operating times were compared with those of 24 patients under-going the removal of similar masses by laparotomy. Measurements and Main Results. Three masses were functional cysts, 4 were tubal cysts, 4 were endometriomas, and 20 were benign ovarian neoplasms. There were no malignancies. Peritoneal spillage occurred during one ovarian cystectomy. The only complication was bleeding from the cannula site. Comparing laparoscopy and laparotomy, average operating time was 73.45 minutes (range 34–148 min) and 81 minutes, average length of hospital stay was 17.4 hours (range 6–73 hrs) and 2.92 days, and average hospital cost was $2401 and $3539, respectively. Conclusion. Laparoscopic access provides a cost-effective method of removing adnexal masses with a very small risk of peritoneal spillage. When managed in this manner, rather than laparotomy, the cost reduction was significant.