Mesial side ovarian incision for laparoscopic dermoid cystectomy A safe and ovarian tissue preserving technique

Capsule:
Considering the greater ovarian cortical thickness at the mesial side, this incision could provide better identification of the cleavage plane, reducing cyst rupture risk and also sparing ovarian residual function.

Authors:
Michele Morelli, M.D., Ph.D., Rita Mocciaro, M.D., Roberta Venturella, M.D., Alberto Imperatore, M.D., Ph.D., Daniela Lico, M.D., Fulvio Zullo, M.D., Ph.D.

Volume 98, Issue 5, Pages 1336-1340.e1, November 2012

Abstract:

Objective:
To evaluate safety and efficacy, in terms of spillage risk and ovarian tissue-preservation, of mesial incision for laparoscopic dermoid cystectomy.

Design:
Randomized controlled trial.

Setting:
University

Patients:
Sixty-seven women with dermoid cysts.

Interventions:
Laparoscopic dermoid cystectomy performed by mesial incision (33 patients, study group) or antimesial incision (34 patients, control group).

Main outcomes:
Spillage of intracystic content rate, operative times, chemical peritonitis rate, intraoperative blood loss (Δ Hb) as primary outcomes. Post-operative ovarian reserve (Δ FSH levels, basal antral follicle number, mean ovarian diameter, peak systolic velocity at 3 and 12 months after surgery) as secondary outcome.

Results:
Spillage of intracystic content rate (P < 0.05) and operative time (P < 0.001) were significantly lower in study than in control group. None developed chemical peritonitis. ΔHb was higher in the study group, but not significantly. During the follow-up, median FSH values were significantly lower in the study group, with no differences in the E2 levels. Moreover, median basal antral follicle number, median ovarian diameter and median peak systolic velocity were significantly higher in the study group. Conclusions:
Ovarian mesial-side incision appears to be a safe and also tissue-sparing technique.

Clinical trial registration number:
NCT01590030

  • Micah Hill

    Thank you for the nice RCT comparing mesial and antimesial ovarian incisions for dermoid cystectomy. It would have been nice to have AMH levels in addition to the FSH and estradiol levels you mention. You mention that the mesial incision is near the hilum and it seems your group was experienced with this technique prior to this trial. Do you find there is a learning curve associated with the technique you describe? Also, was the ultrasonographer who performed 3 and 12 month exams blinded to the surgical randomization?

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