Laparoscopic Surgery in the Management of Ovarian Masses

Author(s): Varsha Ojha, Vinod Kumar Singhal, Faris Dawood Alaswad, Nufra Senopher Mohamed Sarfraz

Background:

Ovarian masses, including benign cysts, endometriomas, and ovarian cancer, are common in clinical practice and vary in severity. While many remain asymptomatic early on, they can lead to advanced disease and complications if not detected early. Traditionally, exploratory laparotomy was used for surgical management, but advancements in minimally invasive laparoscopic surgery have led to its adoption as the gold standard. Laparoscopy offers advantages such as reduced postoperative pain, faster recovery, and better cosmetic outcomes. It also provides superior visualization, improving surgical precision and safety, even for larger masses, with positive outcomes reported in several cases.

Aim of the study:

The study aims to evaluate the safety and practicality of laparoscopic surgery for large ovarian masses that are presumed to be benign before surgery.

Methods:

This prospective observational study was conducted at Prime Hospital, Dubai, over one year, enrolling 115 female patients with ovarian masses from June 2019 to July 2024. Inclusion criteria included patients aged 10+ years with ultrasonographically confirmed ovarian cysts and no preoperative malignancy indicators. Exclusion criteria were contraindications for laparoscopic surgery and ultrasonographic signs of malignancy. Laparoscopic procedures were performed under general anesthesia, with cystectomy, oophorectomy, or hysterectomy based on clinical factors. Data on demographics, clinical findings, tumor markers, complications, and postoperative follow-up were collected. Histopathological analysis confirmed diagnoses. Data were analyzed using SPSS, with continuous variables expressed as mean±SD and categorical data as percentages.

Result:

The study involved 115 participants, predominantly aged 21- 30 years (60.87%), with a mean BMI of 24.56±1.87 kg/m². Most had no children (41.74%) and reported infertility (44.35%) and dysmenorrhea (36.52%). Ultrasonography revealed ovarian cysts (49.57%) with sizes of 4-6 cm. Preoperative complications occurred in 16.52%, mainly cyst rupture. Laparoscopic oophorectomy or salpingo-oophorectomy was the most common procedure (40.87%), with serous cyst adenoma being the most frequent diagnosis (43.48%). Surgical outcomes included a mean operation time of 65.78 minutes and minimal blood loss (39.62 mL). Postoperative complications included fever (22.61%) and port site infection (11.30%).

Conclusion:

Laparoscopic surgery effectively manages ovarian masses, including large benign cysts, with minimal complications, reduced blood loss, and faster recovery. Procedures like oophorectomy and salpingooophorectomy showed a mean operation time of 65.78 minutes and an average hospital stay of 3.89 days, offering significant advantages over traditional methods.