Laparoscopic Management of Dermoid Cyst
The dermoid cyst is a benign cystic teratoma which is located on the ovary and occurs in 10-15% of the cases. The dermoid cysts can be diagnosed while a pelvic examination or ultrasounds since there are no clinical symptoms of the condition. After the diagnosis, the best alternative for removing the dermoid cyst is the surgery, because there is a risk of chemical peritonitis or a rupture. Whichever the approach is, it has to be applied adequately in order to avoid any consequences afterwards. The dermoid cyst can be managed easily, applying some techniques.
How the dermoid cyst is managed?
- The laparoscopic approach of the dermoid cysts brings some disadvantages, as a method for managing the cyst. A three-puncture technique is employed in the umbilical trocar in order to insert the telescope and 2 other puntures for the intervention. This approach can minimize the adhesion and the fertility that might be compromizing.
- The dermoid cysts can be removed successfully with this technique.
- Another traditional therapy for these cysts is the cystectomy or the oophorectomy.
- By a statistics, traditional methods were applied on the patients with dermoid cyst and all of them were under general anesthesia. The diagnostic laparoscopy was used in order to evaluate the abdomen and the pelvis, after the pneumoperitoneum was accessed.
How was the procedure evaluated?
After the pneumoperitoneum was accessed, the peritoneum needs to be washed. The ovaries need to be examined if there is some malign condition or any suspicious lesion.
In order to remove the dermoid cyst few steps need to be done.
- 1st was created a cleavage plane between the ovary’s stroma and the cysts and then the cyst is enucleated. If any spillage occurs, then Ringer solution has to be applied to clean the contents of the cyst.
- 2nd technique, a laparoscopic needle is inserted and the cyst content is aspirated through that. It was totally removed by a trocar sleeve.
- 3rd technique that will help in the management of dermoid cyst is the posterior colpotomy. After the colpotomy the pneumoperitoneum has to be inspected carefully and to be performed a homeostasis using bipolar forceps.
Applying jet-wash irrigation
- This is probably appropriate after every removal of the dermoid cyst, where irrigation with suction will be made. Here the responsible person needs to be careful and to avoid spreading fluids in the upper abdomen. This way the pelvis will be clear and no residue of cyst will be left there.
- The irritation effects of the dermoid cyst can be handled with copious fluid dilutes.
- The dermoid cysts nowadays are one of the most common benign cysts on the ovary and can occur to any woman.
- The reason is still unknown for their appearance, but surgical approach is the best solution in treating the cysts.
- If spillage of some contents happens, then chemical peritonitis or an infection will be the consequence. The possibility a spillage to happen during the laparoscopic approach is higher than the laparotomy.
- Apart from this, spillage can occur in almost 66% of the cases and the postoperative complications can be seen in rare cases. The symptom of the postoperative complications is granulomatous peritonitis which is chronic and occurs 9 months after the operation.
- There are no strict rules to be guided on while doing the laparoscopy, if no spillage is done, you will just have to do the jet wash irrigation and remove the contents of cyst.
- Also it is considered that the size of the cyst is not the reason for the spillage.
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