Laparoscopic management of extremely large ovarian cysts

To assess the feasibility and outcome of laparoscopic surgery for the management of extremely large ovarian cysts. From July 2000 to December 2003, 21 patients with extremely large ovarian cysts were managed laparoscopically. The masses were cystic or complex, reached the umbilicus or higher, and were not associated with ascites or enlarged pelvic or para-aortic lymph nodes on computed tomography scan. Serum CA 125 levels were within the normal range or mildly elevated (< 130 mIU/mL). The mean and median ages of the patients were 45 +/- 20 and 46 years, respectively (range 17-89 years). Seven women were postmenopausal and the rest were premenopausal. The patients underwent cystectomy or adnexectomy depending on each patient's age and obstetric history. Two laparoscopies were converted to laparotomy, one because of ovarian malignancy and the second because of technical difficulties related to morbid obesity and severe intra-abdominal adhesions. The postoperative recovery was uneventful in all women. With proper patient selection, the size of an ovarian cyst is not necessarily a contraindication for laparoscopic surgery.