Role of minimally invasive surgery in complex adnexal tumours and ovarian cancer

Table 1 Operative evaluation of macroscopic characteristics predicting the potential of malignancy in adnexal masses

Multiloculation

Aberrant neovascularization at ovarian surface

Thick cystic wall

Papillary excrescences

Firm adhesions

Ascites

Bilaterallity

Infiltration of surrounding structures

Table 2 Surgical manoeuvres in order to decrease port-site metastasis in the laparoscopic management of complex adnexal masses

Using wound protectors

Minimizing tumour manipulation

Anchoring ports to prevent dislodgment

Avoiding carbon dioxide leakage and sudden desufflations

Using gasless laparoscopy

Irrigating and suctioning the abdomen, instruments and ports before removal

Using heparin or 0.25%-1% povidone-iodine solution to irrigate wounds and the abdomen

Excising trocar sites and deliberate closure of all abdominal layers including the peritoneum after laparoscopy; or postoperative port-site radiation

Resuming definitive surgery or chemotherapy early

Using 5-fluorouracil, topical taurolidine or intraperitoneal endotoxin