This video demonstrate laparoscopic cystectomy for ovarian teratoma. Germ cell tumours begin in egg cells in women or sperm cells in men. There are 2 main types of ovarian teratoma: mature teratoma, which is non cancerous (benign). immature teratoma, which is cancerous. Immature teratomas are usually diagnosed in girls and young women up to their early 20s. These cancers are rare. They are called immature because the cancer cells are at a very early stage of development. Most immature teratomas of the ovary are cured, even if they are diagnosed at an advanced stage. Keywords: Laparoscopy, Dermoid cyst, Ovarian cyst, Operative laparoscopy. Benign cystic teratomas, or dermoid cysts, are germ cell tumors of the ovary that account for 20-25% of all ovarian tumors and are bilateral in 10-15% of cases. They have a low incidence of malignancy, reported as 1-3%. The majority of dermoid cysts are asymptomatic and are often discovered incidentally upon pelvic exam. The potential for complications such as torsion, spontaneous rupture, risk of chemical peritonitis, and malignancy usually makes surgical treatment necessary upon diagnosis. Traditional therapy for a dermoid cyst has been cystectomy or oophorectomy via laparotomy. The laparoscopic approach has become increasingly accepted since 1989. Because most patients with cystic teratomas are of reproductive age, a conservative approach is ideal; laparoscopy may minimize adhesion formation and thus decrease the chance of compromising fertility. The management of ovarian teratomas in normal conditions is well established, but in rare giant cases (tumor diameter over 15 cm), the choice of management, such as laparotomic or laparoscopic approaches, are controversial and may be therapeutically challenging for surgeons.

Ovarian teratomas, commonly known as dermoid cysts, are benign ovarian tumors that arise from germ cells and contain tissues derived from all three germ layers—ectoderm, mesoderm, and endoderm. They account for approximately 10–20% of all ovarian neoplasms and are most frequently seen in women of reproductive age. Although often asymptomatic, they can occasionally present with abdominal pain, menstrual irregularities, or complications such as torsion or rupture.

Traditional Management vs. Laparoscopic Approach

Historically, ovarian teratomas were managed through open laparotomy, which required a larger abdominal incision and was associated with longer recovery times, increased postoperative pain, and higher morbidity. With advancements in minimally invasive surgery, laparoscopic management has become the preferred method for treating ovarian teratomas due to its numerous benefits:

• Reduced postoperative pain

• Shorter hospital stay

• Faster return to daily activities

• Superior cosmetic outcomes

• Better preservation of ovarian tissue and fertility

Indications for Laparoscopic Surgery

Laparoscopic management is indicated for:

• Symptomatic ovarian teratomas

• Asymptomatic cysts larger than 5–6 cm (due to risk of torsion)

• Cysts with solid components suspicious for malignancy (with caution)

• Recurrent dermoid cysts

Preoperative evaluation with ultrasound or MRI helps in determining cyst size, morphology, and vascularity, which aids in surgical planning.

Surgical Technique

1. Patient Preparation

• General anesthesia is administered.

• The patient is positioned in a dorsal lithotomy or supine position.

• Pneumoperitoneum is created using a Veress needle or Hasson technique.

2. Port Placement

• A 10–12 mm umbilical port for the laparoscope.

• Two or three accessory ports (5 mm) are placed in the lower abdomen for surgical instruments.

3. Cyst Exposure and Handling

• The ovary is carefully mobilized.

• Aspiration of cyst contents may be performed to reduce size and facilitate removal, although spillage should be minimized due to risk of chemical peritonitis.

• The cyst wall is dissected from ovarian tissue, preserving as much healthy ovarian tissue as possible.

4. Specimen Retrieval

• The cyst is placed in an endoscopic retrieval bag before removal to prevent spillage.

• The specimen is then extracted through the umbilical port.

5. Hemostasis and Closure

• Meticulous hemostasis is achieved using bipolar cautery or sutures.

• Ports are closed, and the patient is monitored postoperatively.

Advantages of Laparoscopy

• Fertility Preservation: Conservative cystectomy allows preservation of ovarian tissue.

• Reduced Complications: Lower risk of infection, adhesions, and wound complications compared to laparotomy.

• Quick Recovery: Most patients can resume normal activities within a few days.

Potential Complications

While laparoscopy is generally safe, potential complications include:

• Cyst rupture and spillage causing chemical peritonitis

• Injury to adjacent organs (bowel, bladder, ureter)

• Bleeding

• Recurrence of cyst

Careful surgical technique and use of retrieval bags significantly reduce these risks.

Postoperative Care

• Patients are usually discharged within 24–48 hours.

• Follow-up includes ultrasound imaging to detect recurrence.

• Hormonal monitoring may be advised in reproductive-age women to assess ovarian function.

Conclusion

Laparoscopic management of ovarian teratomas is a safe, effective, and fertility-preserving approach that has become the standard of care for appropriately selected patients. With proper preoperative evaluation, meticulous surgical technique, and careful postoperative follow-up, patients can enjoy excellent outcomes with minimal complications.