Published online Aug 26, 2020. doi: 10.12998/wjcc.v8.i16.3527
Peer-review started: May 5, 2020
First decision: May 21, 2020
Revised: May 27, 2020
Accepted: July 30, 2020
Article in press: July 30, 2020
Published online: August 26, 2020
Processing time: 112 Days and 1 Hours
Giant ovarian cysts (≥ 15 cm in diameter) are rare. The size limit of cysts and the methodology for a safe and successful minimally invasive surgery has not been established. Here we report a case of a large 10-kg multi-locular ovarian mass, which was successfully laparoscopically removed: Our aim was to innovate the surgical practice in this field by providing a safe, effective, and minimally invasive management method for such complex and rare cases.
A 49-year-old nulliparous woman presented with abdominal distension, lasting from six Mo prior to admission; she reported worsening abdominal pain, abdominal swelling, and mild dyspnea. Imaging showed a presumed benign multi-locular (> 10 locules) left ovarian cyst that measured about 30 cm in diameter. Based on the IOTA-ADNEX model the mass had a 27.5% risk of being a borderline or malignant tumor. The patient was successfully treated via a direct laparoscopic approach with salpingo-oophorectomy, followed by the external drainage of the cyst. Tumor spillage was successfully avoided during this procedure. The final volume of the drained mucinous content was 8950 L; the cyst wall, extracted through the minilaparotomy, weighed about 1200 g. The pathologic gross examination revealed a 24 cm × 15 cm × 10 cm mass; the histologic examination diagnosed a mucinous cystoadenoma. To our knowledge, this is the first case of a giant multi-locular ovarian cyst treated with a direct laparoscopy with salpingo-oophorectomy followed by external decompression.
Choosing the appropriate technique and surgeon skill are necessary for a safe and effective minimally-invasive approach of unique cases involving giant ovarian cysts.
Core tip: To date, there are no standard guidelines regarding the maximum size of cysts that can be safely and effectively laparoscopically treated. To our knowledge, our case report is the first to describe a very large multi-locular ovarian cyst weighing 10150 g that was treated via a direct laparoscopic approach with salpingo-oophorectomy, followed by external decompression. Choosing the most appropriate technique is necessary for safely and effectively treating unique cases involving large cysts, and this choice is dependent on the experience and efficiency of the surgical team.