Title: Laparoscopic guided minilaparotomy. A modified technique for management of benign
large ovarian cysts.
Version: 4 Date: 28 Apr 2022
Reviewer:  Michel Canis
Reviewer's report:
This paper describes an interesting approach. I am sorry for the author to say that this is not at
all an innovation. This technique was the first laparoscopic approach. Indeed when laparoscopic
forceps were not good enough to perform an intra peritoneal cystectomy, we developed what
we called extra abdominal cystectomy. This technique mainly disappeared with progresses of
laparoscopic forceps but we still teach it for very large cyst. It is true that we did not studied AMH
(not available at that time) but we did published fertility and pregnancy rates (above 85%) after
the laparoscopic treatment of ovarian cyst and in this paper many patients had an extra abdominal
cystectomy. We also used this approach in large cysts. The references are listed below.
I have three comments which need to be included in the discussion section,
First large cysts are more likely to be malignant and if there is any doubt about malignancy
abdominal wall contamination should be prevented. It was classically a contra indication to this
approach as the abdominal scar is a good site for metastasis. Nowadays this may be avoided
using Alexis retractor before puncturing the cyst to protect the wall.
Second the advantage is not hemostasis, if the plane is correct hemostasis is not an issue in the
treatment of large benign non endometriotic cyst. The main advantage of this approach is to
facilitate ovarian preservation in very large cyst, particularly when there are multiple cysts in
the same ovary.
Third, endometriomas are in our opinion not a good indication of this approach. Indeed these
cyst should be drained during the adhesiolysis. The cyst it self is stuck to the broad ligament,
so that the cyst should not be punctured in another place to avoid two ovarian incisions. So
that doing the cystectomy outside the abdomen is not always possible. We do insist that cyst
rupture on the adhesion site to the broad ligament will not be avoided beginning the cystectomy
in another place of the ovary because the cyst is itself is fixed to the broad ligament. So that this
approach should be recommended for endometrioma until the results of the study which will be
performed become available.
1.
Laparoscopic Management of Suspicious Adnexal Masses.
Canis M, Mage G, Pouly JL, Wattiez A, Glowaczower E, Raiga J, Bruhat MA.
J Am Assoc Gynecol Laparosc. 1994 Aug;1(4, Part 2):S6. doi: 10.1016/
s1074-3804(05)80884-9.
PMID: 9073662
2.
Laparoscopic diagnosis of adnexal cystic masses: a 12-year experience with long-term follow-
up.
Canis M, Mage G, Pouly JL, Wattiez A, Manhes H, Bruhat MA.
Obstet Gynecol. 1994 May;83(5 Pt 1):707-12.
PMID: 8164928
3.
Fertility following laparoscopic management of benign adnexal cysts.
Canis M, Bassil S, Wattiez A, Pouly JL, Manhes H, Mage G, Bruhat MA.
Hum Reprod. 1992 Apr;7(4):529-31. doi: 10.1093/oxfordjournals.humrep.a137684.
PMID: 1387882
4.
Laparoscopic management of adnexal cystic masses.
Mage G, Canis M, Manhes H, Pouly JL, Wattiez A, Bruhat MA.
J Gynecol Surg. 1990 Summer;6(2):71-9. doi: 10.1089/gyn.1990.6.71.
PMID: 10150016
5.
[Laparoscopic treatment of ovarian cysts. Indications, techniques, results. Apropos of 650
cases].
Bruhat MA, Mage G, Bagory G, Canis M, Pouly JL, Wattiez A, Chapron C, Laberge P.
Chirurgie. 1991;117(5-6):390-7.
PMID: 1840134 French.