Laparoscopy-assisted Ovarian Cystectomy: NEW APPROCH
Condition: Ovarian Cysts
MeSH terms: Ovarian Cysts
Study type: Interventional

Summary: 
      Under general anaesthesia, the patient is placed in the modified dorsal lithotomy position a
      10-mm umbilical trocar is inserted. A panoramic view of the pelvis was obtained together with
      full assessment of the ovarian mass(es).

      Aspiration of the cyst:

      Veress needle is inserted in the midline 2 cm above the symphysis pubis to aspirate the cyst
      under laparoscopic guidance (to guide the entry of the needle into the cyst wall & to confirm
      complete aspiration).

      Delivery of affected ovary outside the abdominal cavity:

      Classic ovarian cystectomy will be done using microsurgical techniques in which the cyst wall
      will be dissected gently and carefully from the healthy ovarian tissue followed by perfect
      haemostasis and re-fashioning of the remaining ovarian tissue using Vicryl (3-0) sutures.

      Re-introduction of the ovary to inside the abdominal cavity:

      The stitched ovary is pushed gently inside the abdominal cavity and the mini-laparotomy is
      re-covered by the rubber shield (to allow re-inflation of the abdominal cavity). The ovary is
      reassessed under laparoscopic guidance to ensure perfect haemostasis and normal position of
      the ovary. Pelvic irrigation is done if needed.
    

Detailed description: 
      Patient positioning and port placement:

      Under general anaesthesia, the patient is placed in themodified dorsal lithotomy position (to
      ensure lax anterior abdominal wall). The patient is thenprepped and draped in the usual
      fashion for an abdominaland vaginal procedure. In non- virgin patients, vaginal speculum is
      inserted into thevagina to expose the cervix, a uterine manipulator is inserted in the cervix
      followed by placement of a Foley's catheter in thebladder. As regards port placement, a 10-mm
      umbilical trocar is inserted. A panoramic view of the pelvis was obtained together with full
      assessment of the ovarian mass(es).

      Aspiration of the cyst:

      Veress needle is inserted in the midline 2 cm above the symphysis pubis to aspirate the cyst
      under laparoscopic guidance (to guide the entry of the needle into the cyst wall & to confirm
      complete aspiration).

      Delivery of affected ovary outside the abdominal cavity:

      A transverse mini-laparotomy is done (2-3 cm) in the midline 2 cm above the symphysis pubis.
      A long shanks artery forceps is introduced inside the abdominal cavity (to grasp the affected
      ovary) under laparoscopic guidance. Then, the artery is pulled gently to the outside to
      deliver the ovary at the mini-laparotomy skin incision. Careful handling and traction is
      applied to avoid injury of both the ovarian tissue or/andinfundibulopelvic ligament.
      Following the delivery of the ovary, the abdominal incision is temporary closed using
      (E-shaped 10 x 10 cm) rubbershield (to avoid any soiling of abdominal cavity with blood or
      cystic fluid & give the chance to reinflate the abdominal cavity later on).

      Ovarian cystectomy:

      Classic ovarian cystectomy will be done using microsurgical techniques in which the cyst wall
      will be dissected gently and carefully from the healthy ovarian tissue followed by perfect
      haemostasis and re-fashioning of the remaining ovarian tissue using Vicryl (3-0) sutures.

      Re-introduction of the ovary to inside the abdominal cavity:

      The stitched ovary is pushed gently inside the abdominal cavity and the mini-laparotomy is
      re-covered by the rubber shield (to allow re-inflation of the abdominal cavity). The ovary is
      reassessed under laparoscopic guidance to ensure perfect haemostasis and normal position of
      the ovary. Pelvic irrigation is done if needed.
    

Intervention name(s): laproscopy; combined laproscopic and minilaparotomy ovarian cystectomy
Intervention type(s): Procedure; Procedure
Intervention description(s): laparoscopic ovarian cystectomy; Under general anaesthesia, the patient is placed in the modified dorsal lithotomy position a 10-mm umbilical trocar is inserted. A panoramic view of the pelvis was obtained together with full assessment of the ovarian mass(es).
Aspiration of the cyst:Delivery of affected ovary outside the abdominal cavity:
Ovarian cystectomy:
Re-introduction of the ovary to inside the abdominal cavity:
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment