Large adnexal masses traditionally are removed surgically via laparotomy through a midline vertical incision to achieve adequate exposure and to avoid spillage of cyst contents. However, large laparotomies carry significant morbidity compared with minimally invasive techniques. Minilaparotomy is a minimally invasive approach that is associated with shorter operating times and lower estimated blood loss compared with laparoscopy in gynecologic surgery.1 The procedure also provides adequate exposure and can be used for carefully selected patients with a large adnexal mass.2,3 Preoperative assessment for the risk of malignancy typically includes an evaluation of risk factors, physical examination, imaging, and tumor markers.4
In this video, we illustrate a minimally invasive technique for the removal of a massively enlarged adnexal mass through laparoscopic bilateral salpingo-oophorectomy with minilaparotomy assistance. We conclude that this procedure is a safe and feasible option for women with a large benign adnexal mass, such as the highlighted patient whose final pathology resulted in a mucinous cystadenoma. Careful patient selection and preoperative assessment of malignancy risk is critical.5,6
We hope that you find this innovative approach useful in your clinical practice.
>> Dr. Arnold P. Advincula and colleagues