Laparo-endoscopic Approach for Large Ovarian Cyst in the Morbidly Obese: Case Report

We report a successful case of laparo-endoscopic single site total hysterectomy and bilateral salpingo-oophorectomy (LESS THBSO) using conventional laparoscopic instruments for a large ovarian cyst in a morbidly obese woman. A 58-year-old female with a BMI of 46kg/m2 complaint of abdominal distension. A pelvic ultrasound revealed a left ovarian cyst measuring 21.3 x 15.2 x 20.8 cm. The IOTA score is 3.5% and the RMI score was 51, suggesting a benign pathology. LESS THBSO was performed and the final histology was a benign ovarian mucinous cystadenoma. The patient recovered well with no postoperative complications. This case demonstrates that LESS is feasible for large ovarian cysts even in morbidly obese patients when appropriate cases are selected and when the patient is managed in a multi-disciplinary team.

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Laparoscopic management of large ovarian cysts

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20171965 ◽

2017 ◽

Vol 6 (5) ◽

pp. 1999

Author(s):

Beeresh C. S. ◽

Divyasree Doopadapalli ◽

Vimala K. V. ◽

Krishna Lingegowda

Keyword(s):

Ovarian Cyst ◽

Operating Time ◽

Serum Marker ◽

Ovarian Cysts ◽

Preliminary Evaluation ◽

Laparoscopic Management ◽

Proper Patient Selection ◽

Benign Pathology ◽

Large Ovarian Cyst ◽

Borderline Malignancy

Background: Large ovarian cysts are conventionally managed by laparotomy. This study was undertaken to assess the feasibility and outcome of laparoscopic surgery for the management of large ovarian cysts.Methods: Thirty-eight patients from January 2014 to December 2016, presumed to be large ovarian cyst were managed laparoscopically. Preliminary evaluation suggestive to be of benign ovarian cyst by history, clinical examination, sonographic imaging and basic serum marker were only included in this study. The cysts were aspirated initially followed by cystectomy, oophorectomy or total hysterectomy depending on age, parity, coexisting pathology and desire for future fertility.Results: Out of 38 cases, 6 were non-ovarian adnexal masses. 8 out of rest 32 cases presented with pain due to torsion were managed on emergency basis, rest of the cases were operated electively. Mean operating time was 90 minutes. Mean size of the cyst was 16 cms. One cases of borderline malignancy were detected and the rest showed benign pathology. Three of the cases required mini Laprotomy for specimen removal. Most of women were successfully treated laparoscopically without any complications and conversion to laparotomy was required in 3 cases.Conclusions: With proper patient selection and exclusion of malignancy, laparoscopic management of large ovarian cyst by general gynecologist is feasible.

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A Massive Ovarian Mucinous Cystadenoma: A Rare Case Report

Delta Medical College Journal ◽

10.3329/dmcj.v3i1.22239 ◽

2015 ◽

Vol 3 (1) ◽

pp. 48-51

Author(s):

Ruma Sen Gupta ◽

Suha Jesmen ◽

Aysha Noor ◽

Shahana Shermin

Keyword(s):

Case Report ◽

Ovarian Cyst ◽

Histopathological Examination ◽

Abdominal Mass ◽

Mucinous Cystadenoma ◽

Abdominal Distension ◽

Cystic Mass ◽

Surface Epithelium ◽

Rare Case Report ◽

Left Fallopian Tube

Ovarian mucinous cystadenoma is a benign tumour that arises from the surface epithelium of the ovary. It tends to be huge in size if not detected early. We describe a 32 year old woman (para 1+0) presented with marked abdominal distension, discomfort and vague pain in the abdomen with dyspepsia, anorexia, nausea, vomiting and irregular menstruation for last three months with the suspicion of pregnancy. On examination no findings were in favour of pregnancy, rather an ill defined abdominal mass about 30 weeks pregnancy size was found. Transabdominal USG revealed a big multiloculated ovarian cyst of about 25x20 cm. On laparotomy a huge cystic mass was noticed arising from left ovary. The cyst wall was smooth, intact and without any external projection though adherent with the left fallopian tube and left salpingo-oophorectomy was done. Histopathological examination revealed an ovarian cyst compatible with mucinous cystadenoma. Such giant ovarian tumours have become rare in current practice. This case report emphasizes the significance of thorough evaluation of all women presented with non specific complaints like vague abdominal pain or simple dyspepsia. Although the condition is rare, it is potentially dangerous in the massive form if not timely diagnosed and managed properly. With the increasing awareness of such conditions, more and more cases could be detected and reported early. DOI: http://dx.doi.org/10.3329/dmcj.v3i1.22239 Delta Med Col J. Jan 2015; 3(1): 48-51

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Anesthetic management of a morbidly obese woman with a massive ovarian cyst

Journal of Clinical Anesthesia ◽

10.1016/0952-8180(93)90091-r ◽

1993 ◽

Vol 5 (1) ◽

pp. 62-68 ◽

Cited By ~ 6

Author(s):

Gregory A. Trempy ◽

Peter Rock

Keyword(s):

Ovarian Cyst ◽

Obese Woman ◽

Anesthetic Management ◽

Morbidly Obese

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Percutaneous tracheostomy in three morbidly obese patients using the ‘Blue RhinoTM ’ technique

Anaesthesia ◽

10.1046/j.1365-2044.2000.01664-13.x ◽

2000 ◽

Vol 55 (9) ◽

pp. 917-919 ◽

Cited By ~ 11

Author(s):

M. J. P. Scott ◽

J. Leigh

Keyword(s):

Percutaneous Tracheostomy ◽

Morbidly Obese ◽

Obese Patients

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Robot assisted gynaecologic procedures in morbidly obese patients

Geburtshilfe und Frauenheilkunde ◽

10.1055/s-0034-1388284 ◽

2014 ◽

Vol 74 (S 01) ◽

Author(s):

C Kurzeder ◽

J Persson ◽

A du Bois ◽

P Kannisto ◽

T Bossmar ◽

...

Keyword(s):

Morbidly Obese ◽

Obese Patients ◽

Robot Assisted

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Hand-assisted laparoscopic nephrectomy in morbidly obese patients

Perspectives in Surgery ◽

10.33699/pis.2020.99.6.271-276 ◽

2020 ◽

Vol 99 (6) ◽

pp. 271-276

Keyword(s):

Body Weight ◽

Surgical Technique ◽

Blood Loss ◽

Hospital Stay ◽

Kidney Cancer ◽

The Body ◽

Laparoscopic Nephrectomy ◽

Morbidly Obese ◽

Obese Patients ◽

Morbid Obese

Introduction: Prevalence of obesity is 30 % in the Czech Republic and is expected to increase further in the future. This disease complicates surgical procedures but also the postoperative period. The aim of our paper is to present the surgical technique called hand-assisted laparoscopic nephrectomy (HALS), used in surgical management of kidney cancer in morbid obese patients with BMI >40 kg/m2. Methods: The basic cohort of seven patients with BMI >40 undergoing HALS nephrectomy was retrospectively evaluated. Demographic data were analyzed (age, gender, body weight, height, BMI and comorbidities). The perioperative course (surgery time, blood loss, ICU time, hospital stay and early complications), tumor characteristics (histology, TNM classification, tumor size, removed kidney size) and postoperative follow-up were evaluated. Results: The patient age was 38−67 years; the cohort included 2 females and 5 males, the body weight was 117−155 kg and the BMI was 40.3−501 kg/m2. Surgery time was 73−98 minutes, blood loss was 20−450 ml, and hospital stay was 5−7 days; incisional hernia occurred in one patient. Kidney cancer was confirmed in all cases, 48–110 mm in diameter, and the largest removed specimen size was 210×140×130 mm. One patient died just 9 months after the surgery because of metastatic disease; the tumor-free period in the other patients currently varies between 1 and 5 years. Conclusion: HALS nephrectomy seems to be a suitable and safe surgical technique in complicated patients like these morbid obese patients. HALS nephrectomy provides acceptable surgical and oncological results.

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