Management of large ovarian cyst with pregnancy
by Jain Nutan, Jain Vandana

Comprehensive Video Atlas of Laparoscopic Surgery in Infertility and Gynecology

by Nutan Jain
About Video

This is a case of 32 years-old-female present complaints of four months pregnancy with severe pain in abdomen. Ultrasonography shows a huge echo poor mass noted about the size of 21 cm × 18 cm near by the gravid uterus. Color Doppler–normal indices. Tumor marker CA-125, LDH, b-hCG, AFP = Within normal limits. Twenty eight weeks pregnancy with large ovarian cyst. Patient laid in modified lithotomy position under GA. Four ports laparoscopy done, all 5 mm ports except camera port which is 10 mm. A standard four ports laparoscopy was done. Supra-umbilical 10 mm port was given under the direct vision of 5 mm port, which was made at the left paraumbilical position. Low intraperitoneal pressure was maintained throughout the surgery. A huge slightly bluish colored ovarian cystic mass occupying whole of the abdomen noted, just behind a 16 weeks gravid uterus. No surface excrescences noted over the cyst. The gravid uterus was avoided in all manipulations. The cyst was seen to be twisting so untwisting carried out first. Then the cyst was aspirated by directly inserting the trocar into it and aspirating all cyst contents which was sent for HPE. After the cyst was decompressed an oophorectomy was performed after taking consent. The large cyst lining was morcellated and removed. Cyst lining was sent for HPE. HPE report confirmed benign serous content of this cyst and it’s lining. Patient delivered at full-term. She is having an ongoing second pregnancy also after this procedure.

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