References AWS

The Use of Uterine Evacuation Cannulae to Drain Dermoid Cysts Mr. Ben Peyton-Jones, Mr. Jonathan Ash, Royal Devon and Exeter NHS Foundation Trust Benign cystic ovarian tumors are the most common benign ovarian tumors, accounting for 1 20% of all ovarian tumors. They are bilateral in 10-15% of cases and the incidence of malignancy is low at 1-3%.2 Laparoscopic cystectomy, particularly in younger women is now the accepted method of treatment, resulting in quicker discharge and less surgical related morbidity. A recognised surgical pitfall of laparoscopic treatment is that of surgical spillage. The rates of this are 154 100% compared to 4-13% for laparotomy . Whilst in most cases this is not problematic, it can lead to chemical peritonitis with an incidence of between 0.23 and 8%5 which can lead to pain, bowel obstruction and infertility. Retrieval of spilled contents is therefore crucial. Particularly for larger cysts, the contents must be drained before removal can occur through a standard 11mm incision. The fluid contents of dermoid cysts are very viscous and conventional laparoscopic devices frequently block. We suggest placing the cyst into a strong bag (Cory bros – secure catch retrieval pouch 125x175mm), bring the neck of the bag onto the abdominal surface then use a 8mm suction cannula, as used for evacuation of retained products of conception to empty the bags contents. If there has been any spillage fill the pelvis with saline which will cause the spilled contents to float. The cannula can then be inserted through an 11mm suprapubic port and used to hoover up the floating debris taking care not to entrap bowel. This cheap method (£5) is extremely effective and in our experience results in a greater retrieval of spilled contents, less need to extend incisions and a faster operating time.

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Peterson WF, Prevost EC, Edmunds FT, Handley JM, Morris FK. Benign cystic teratoma of the ovary; a clinico-statistical study of 1007 cases with review of literature. Am j Obstet Gynecol. 1957;72:1094 Curling OM, Potsides PN, Hudson CN. Malignant change in benign cystic teratoma of the ovary. Br J Obstet Gynecol. 1979;86:399-402 Nezhat CR, Kalyoncu S, Nezhat CH, Johnson E, Berlanda N, Nezhat F Laparoscopic management of ovarian dermoid cysts: Ten years experience. JSLS 1999;3:179-184 Shamshirsaz AA, Vibhakar JL, Broadwell C, Van Voorhis BJ. Laparoscopic managemen of chemical peritonitis caused by dermoid cyst spillage. JSLS 2011;15:403-15 Kondo W, Bourdel N, Cotte B, Tran X, Botchorishvili R, Jardon K et al Does prevention of intraperitoneal spillage when removing a dermoid cyst prevent granulomatous peritonitis? BJOG 2010;117:1027-30