Laparoscopic approach to dermoid cysts: Combined surgical technique and ultrasonographic evaluation of residual functioning ovarian tissue

Abstract Study Objective To estimate how and if laparoscopic removal of ovarian dermoid cysts is a tissue-sparing procedure. Design Prospective study (Canadian Task Force classification II-2). Setting University-associated hospital. Patients Fifty-five women. Intervention Laparoscopic removal of ovarian dermoid cysts by a combination of hydrodissection and blunt dissection, and transvaginal sonographic (TVS) evaluation of residual ovarian tissue. Measurements and Main Results Within 1 week before surgery all recruited patients underwent TVS evaluation of ovarian volume, size, and morphology of dermoid cysts and measurement of surrounding ovarian cortex. Mean cyst diameter was 5.5 ± 2.2 cm (range 2.1–15.0 cm). Within 6 to 12 months after laparoscopic excision, TVS measurements of residual ovarian tissues were obtained. Ovarian residual cortex surrounding the cyst was not visible at TVS in 24 ovaries, whereas in 56 ovaries residual tissue volume was greater than 3 cm 3 after laparoscopic excision. Conclusion We propose laparoscopic removal of dermoid cysts by combining hydrodissection and blunt dissection with maximum tissue sparing, even when the cyst seems to fill the ovary and no surrounding ovarian cortex can be seen on ultrasound.