A comparative study of laparoscopy and colpotomy for the removal of ovarian dermoid cysts

OBJECTIVE: To compare laparoscope-assisted transvaginal removal of dermoid cysts to more standard laparoscopic cystectomy techniques. METHODS: We conducted a retrospective review of 44 laparoscopic dermoid removals performed at Olive View-UCLA Medical Center between 1992 and 1995. Cases were divided into three groups based on surgical approach: 1) conventional laparoscopic ovarian cystectomy, 2) laparoscopic ovarian cystectomy and removal of the freed mass via colpotomy, and 3) laparoscopic inspection, then transvaginal cystectomy via colpotomy. Surgical time, estimated blood loss, cyst spillage, and complications were compared. RESULTS: There were 11-19 patients in each group. The groups were similar in patient age, parity, and weight. Larger cysts tended to be removed by the laparoscopy-colpotomy techniques (mean diameter 10 cm) rather than by the purely laparoscopic approach (mean diameter 7 cm, P < .05). Cyst spillage occurred less often (43%, P < .05) and surgical time was shortest (mean 81 minutes, P < .05) with laparoscope-assisted transvaginal ovarian cystectomy compared with conventional laparoscopic techniques. Disposable laparoscopic instruments were used less often with transvaginal cystectomy (7%) than with conventional laparoscopic cystectomy (77%, P < .01). The difference in mean estimated blood loss in the cases using colpotomy (89 mL) compared with cases that did not (65 mL) was not statistically significant. Among the three groups, there were four major operative complications related to blood loss and infection. CONCLUSION: Laparoscope-assisted transvaginal ovarian cystectomy allows the removal of larger dermoid cysts, with less cyst spillage and savings in operative time and equipment compared with conventional laparoscopic cystectomy.

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