Fast Leak-Proof, Intraumbilical, Single-Incision Laparoscopic Ovarian Cystectomy for Huge Ovarian Masses: "Hybrid Cystectomy and Reimplantation" Method

Application of transumbilical single port laparoscopic surgery for adnexal masses in pregnancy

OBJECTIVE

To evaluate the safety and feasibility of single-port laparoscopy during pregnancy in short term and long term.

METHODS

A multicenter retrospective study was conducted to investigate the clinical data of 38 pregnant women with adnexal masses who underwent transumbilical single-port laparoscopic surgery from January 2017 to March 10, 2023.

RESULTS

The mean operation time was 72.7 ± 29.6 (30-160) min. The mean intraoperative blood loss was 30.5 ± 80.4 mL, the mean postoperative first defecation time was 2.5 ± 0.7 days, and the mean total hospital stay was 6.9 ± 1.4 days. None of the patients used analgesic drugs postoperatively. Two patients developed missed abortions within 1 month of surgery, one underwent induction of labor due to a dead fetus at 24 weeks and 5 days of gestation, and the other patients did not develop adverse events after surgery. Mean birth weight was 3322.3 ± 396.3 g. The fetal heart rate was 139 ± 6.4 bpm before operation and 149 ± 2.7 bpm after operation. The APGAR score at 1 and 10 min was 9.2 ± 0.6 points and 9.9 ± 0.2 points, respectively. The mean follow-up time was 23.9 ± 16.1 (4.7-56) months, 90% (27/30) of the children had moderate developmental quotient, and 10% (3/30) of the children had good developmental quotient, without borderline low developmental quotient or mental retardation.

CONCLUSION

It is safe, practical, and worthwhile to promote transumbilical single port laparoscopic surgery for pregnancies with adnexal masses in both short and long term.

A preoperative scoring system to predict the probability of laparoendoscopic single-site extracorporeal cystectomy in patients with benign ovarian cysts

Objective

To develop a preoperative scoring system (PSS) to predict whether laparoendoscopic single-site extracorporeal (LESS-E) cystectomy can be performed in patients with benign ovarian cysts.

Method

We reviewed data on patients who underwent LESS cystectomy between August 2016 and October 2019 at the first Affiliated Hospital, Army Medical University. The independent predictors of LESS-E cystectomy in patients with benign ovarian cysts were identified using multivariate logistic regression analyses. A nomogram for predicting LESS-E cystectomy in patients with benign ovarian cysts was developed, and to simplify the score, we establish a preoperative scoring system to guide the choice of surgical approach in patients with highly probable benign ovarian cysts.

Results

Our analysis showed that age, BMI, height and the diameter of ovarian cysts were independent predictors of LESS-E cystectomy. A nomogram was developed based on these four factors, which had a concordance index of 0.838 and R2 = 0.415. To simplify the score, the predicted indicators in the regression model were scored by dividing the beta coefficient by the absolute value of the minimum beta coefficient, and the sum of each predictor score established a PSS. In the total set, the selected cutoff value according to the maximum point of the Youden index was 8, and a preoperative score ≥ 8 identified patients undergoing LESS-E cystectomy with a positive predictive value of 67.4% and a negative predictive value of 88.6%.

Conclusion

A PSS to predict the chances of LESS-E cystectomy was established. This system could be helpful for selecting the appropriate surgical strategy for patients with benign ovarian cysts.