P–303 Similar long term recurrence rates with cystectomy and CO2-laser vaporization for endometrioma: a retrospective study

Study question Is there a difference in recurrence rate of endometrioma(s) after cystectomy versus CO2-laser vaporization of the cyst wall? Summary answer Similar rates of imaging based recurrence or need for reintervention for endometrioma were observed after cystectomy versus CO2-laser vaporization. What is known already Surgical treatment of endometrioma(s) is mainly performed by 2 types of procedures: cystectomy and ablation. When performing surgery for endometrioma(s), a balance should be made between minimal destruction of normal ovarian cortex and maximal completeness to avoid (early) recurrence. Previous studies have shown that cyst recurrence rates were higher with ablation using bipolar current than after cystectomy. However, only 2 groups have evaluated recurrence rates after cystectomy versus CO2 laser vaporization and found no difference with extended follow-up. Furthermore, ablation with CO2 laser may be less invasive than conventional cystectomy with increased preservation of antral follicles in favor of ablation. Study design, size, duration Single-center retrospective study on data of 271 patients operated between January 2010 and December 2014. Participants/materials, setting, methods Women of reproductive age (18–45 years), undergoing CO2 laser laparoscopic excision of any rAFS-stage endometriosis with at least one endometrioma, were eligible for the study. All 271 included patients were treated in a tertiary referral center for endometriosis of a University Hospital, and underwent complete CO2-laser laparoscopic surgery for endometrioma(s). 155 underwent cystectomy, 77 CO2 laser vaporization, and 46 a mixed technique. Main results and the role of chance The mean duration of follow-up was 58 months. Primary outcome studied was the comparison of recurrence rates between cystectomy and vaporization; secondary outcomes included pregnancy rate and ovarian reserve testing. Recurrence was defined as either imaging based (i.e. cyst recurrence identified at ultrasound and/or MRI) or need for reintervention for suspected cyst recurrence. Imaging based recurrence was reported in 9.92% of patients (n = 12/121) treated with cystectomy and in 11.76% of patients (n = 6/51) who underwent a CO2 laser vaporization (p = .62). The need for reintervention for endometrioma(s) was also similar in both groups, with a rate of 3.23% (n = 5/155) after cystectomy and 4.29% (n = 3/70) after CO2 laser vaporization (p = .567). No difference was seen regarding AMH drop pre- versus postoperatively (p=.233). The 2 study groups were similar, except for the mean cyst diameter, which was higher in the cystectomy group (42.36 ± 25.49 mm) compared to the CO2 laser vaporization group (31.7 ± 26.98 mm) (p = <.001). This suggests that smaller endometriomas might be more likely to undergo CO2 laser vaporization. Limitations, reasons for caution The retrospective character of the study may induce information bias concerning the registration of recurrence. Moreover, regarding the evaluation of imaging-based recurrence, a selection bias cannot be excluded, because most likely only patients complaining about pain would be referred for an ultrasound or planned for a reintervention. Wider implications of the findings: In this study, similar rates of recurrence for endometrioma(s) were observed after cystectomy versus CO2-laser vaporization. Since previous studies suggested that CO2-laser vaporization may cause less damage to the adjacent ovarian tissue, we consider this a valuable alternative technique, especially for women with a future child wish. Trial registration number S59032

COMPLICATIONS OF OPEN SURGICAL PROCEDURES IN PATIENTS WITH PANCREATIC CYSTS

The incidence of pancreatic cysts is constantly growing due to an increasing number of patients with a history of pancreatitis. Furthermore, complications after surgical interventions for pancreatic cysts occur in 30-40% of patients. Objective: to analyze the complications in patients with pancreatic cysts after open surgery. We observed 68 patients who underwent open surgical interventions: cystogastrostomy and cystojejunostomy. All patients with pancreatic cysts were divided into 2 groups depending on the type of procedure. In 27 patients (29%) of the first group cystogastrostomy and in 41 patients (81%) of the second group cystojejunostomy was performed. In 1st group complications were diagnosed in 8 cases (29.6%): postoperative pancreatitis (5 — 18.5%), cyst recurrence (3 — 11.1%). In the second group complications occurred in 7 patients (17.1%): postoperative pancreatitis in 4 cases (9.8%), recurrent cysts in 3 cases (7.3%). Thus, cystojejunostomy is less associated with complications than cystogastrostomy. K E Y W O R D S — pancreatic cy

Microsurgical Resection of a Lumbar Synovial Cyst: 2-Dimensional Operative Video

Lumbar spine synovial cysts develop from degenerated zygapophyseal joints. Symptomatic patients present with radicular pain and weakness or neurogenic claudication.1 In the absence of significant concomitant degenerative spondylolisthesis, symptomatic patients can be managed with a laminectomy and microsurgical resection of the cyst, without the need for instrumented fusion.2,3 In this video, we present the microsurgical resection of a left-sided L4-5 synovial cyst in a 68-yr-old man with radicular pain refractory to conservative management. The radiographical features, relevant surgical anatomy, and salient operative steps are reviewed, and strategies for preventing cyst recurrence are emphasized. There were no complications, the postoperative course was unremarkable, and the patient was discharged on postoperative day 1 with significant improvement in his presenting symptoms. No identifying information is present, and patient consent was obtained for the procedure and for publishing the material included in this video.

Recurrence Rates of Dorsal Wrist Ganglion Cysts After Arthroscopic Versus Open Surgical Excision: A Retrospective Comparison

Background This study directly compares the recurrence rates of dorsal wrist ganglion cysts in patients treated via open surgical excision versus arthroscopic surgical excision. We hypothesized that there would be no difference between recurrence rates with these 2 surgical options. Methods We retrospectively reviewed the charts of all patients with a dorsal ganglion cyst undergoing either open or arthroscopic surgical excision at a single academic center with 3 fellowship-trained attending hand surgeons from 2012 to 2017. Charts were identified using Current Procedural Terminology codes and were reviewed using postoperative office notes for preoperative and postoperative symptoms, episodes of recurrence, time at which recurrence occurred, subsequent operations, and outcome at final follow-up. Results The charts of 172 patients undergoing either arthroscopic or open dorsal ganglion excision were reviewed. Nine of 54 (16.7%) arthroscopic excisions resulted in cyst recurrence, while 8 of 118 (6.8%) open excisions resulted in cyst recurrence ( P = .044). Two of 9 (22%) recurrences after arthroscopic ganglion excision versus 2 of 8 (25%) recurrences after open ganglion excision underwent repeat surgical intervention. Time to recurrence, as well as final follow-up, was not statistically different between groups. Conclusions Dorsal wrist ganglion cysts are the most common benign soft tissue mass of the upper extremity, but it remains unknown whether arthroscopic or open surgical excision leads to lower recurrence rate. Scant literature exists directly comparing these 2 methods of surgical excision. This study suggests that open excision of dorsal wrist ganglia leads to a lower recurrence rate than does arthroscopic excision.

Management Options for Suprasellar Cystic Craniopharyngioma: Endoscopic Transventricular Approach and Microsurgical Approach

Objective The treatment of cystic craniopharyngioma in children is varied. The treatment ranges from radical excision to direct radiotherapy. As the morbidity of excision is high, more conservative approaches are used. Transventricular endoscopy is a minimally invasive treatment for cystic craniopharyngiomas. The objective of this study is to compare the outcome of microscopic versus endoscopic transventricular approach for cystic craniopharyngioma. Methods This is a retrospective study of series of children managed with microscopic excision and endoscopic transventricular approach for suprasellar cystic craniopharyngiomas. Operative details, visual outcome, endocrinological outcome, tumor-related cyst recurrence rate, and complication were compared between microscopic and endoscopic groups. Results A total of 28 children underwent microscopic excision and 14 children underwent endoscopic procedure. The anesthesia time was significantly lower with endoscopic as compared to microscopic group (p = 0.0001) as well as blood loss during surgery (p = 0.0001). Hospital stay after surgery was shorter in endoscopic group. Incidence of diabetes insipidus was more in microscopic group (25%) compared to endoscopic group (7.14%). Visual outcome was almost same with approaches. Requirement of hormone replacement was more in microscopic group than in endoscopic group (p = 0.006). Incidence of cyst recurrence was more in microscopic (39.3%) compared to endoscopic group (7.7%). Conclusion Endoscopic transventricular approach is a safe alternative for initial treatment of suprasellar cystic craniopharyngioma in children.

Management of Symptomatic Renal Cysts by Laparoscopy: Our Initial Experience

Introduction and objective: Over the last decade laparoscopic surgery has been popularized and developed to such an extent that it can be considered gold standard for many types of procedures in urology. Currently the majority of operations in urologic field can be performed by laparoscopy. This is because it is as effective as open surgery, but associated with less postoperative pain, shorter hospital stay, faster recovery and has better cosmetic result. The aim of the study is to evaluate the results of our experience of treating symptomatic renal cysts by laparoscopy. Materials and methods: This prospective study was conducted from January 2015 to December 2017 in the Department of Urology in a single unit of Dhaka Medical College Hospital. All the patients were admitted through out-patient department. Among them those who fulfilled the criteria were selected for laparoscopic surgery. All patients were diagnosed by ultrasonography and computed tomography to determine the Bosniak classification of the cyst & informed written consent was taken. Total five laparoscopic decortication of renal cysts were performed and the results of our experience were compared with data from published article. Pain and cyst recurrence were assessed during the follow-up. Results: Our study described the results of 05 laparoscopic decortication of renal cysts. All procedures were completed successfully by transperitoneal approach, with no major intraoperative and postoperative complications. There was a placement of drain tube in one patient. The mean (range) operative duration was 68 (40–110) min, affected by the site and number of cysts decorticated. The mean post operative hospital stay was 1.8 (1- 3) days. All patients were symptom-free and no sign of recurrence during the follow-up. Conclusion: Laparoscopic decortication of symptomatic renal cysts should be the standard of care and it is feasible with conventional laparoscopic instruments and gives a better cosmetic outcome. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.137-139

Endoscopic bimanual sharp dissection technique for gross-total resection of colloid cysts: technical note

Neuroendoscopic resection of colloid cysts has gained tremendous popularity over the last 2 decades because of good clinical outcomes and a low complication profile. However, in comparison to microsurgical resections, endoscopic resection has a lower rate of gross-total resection, which leaves the patient at risk for cyst recurrence. At present, there is still ongoing debate as to the best surgical approach for colloid cysts. Endoscopic resection as a technique has to compete with the good outcomes of microsurgical resections with respect to a long-term recurrence-free outcome. It is the authors’ belief that gross-total resection should be the aim of endoscopic cyst resection. In this technical note, they describe their surgical technique for achieving safe gross-total resection of colloid cysts by using a ventriculoscopic system. The surgical technique includes a far anterolateral entry point, navigational guidance, bimanual sharp dissection, use of the endoscopic sheath as a retractor, the small-chamber irrigation technique, and the dry-field technique for hemostasis.