|[Frontiers in Bioscience 1, g1-7, December 1,1996]|
PLACE AND MODALITIES OF LAPAROSCOPY IN SURGICAL MANAGEMENT OF SUSPECTED ADNEXAL MASSES|
Charles Chapron, Jean-Bernard Dubuisson, Sylvie Capella-Allouc & Xavier Fritel
Service de chirurgie Gynécologique, Clinique Universitaire Baudelocque, C.H.U. Cochin Port-Royal, 123, Boulevard Port-Royal, 75014, Paris, France
Received 9/16/96; Accepted: 9/26/96; On-line 12/01/96
We consider that the existence of an adnexal mass is a contraindication to surgery via the vaginal route (12). So when an adnexectomy is indicated for patients with an adnexal mass, we carried out the operative procedure either by laparoscopy or by laparotomy. For patients presenting with an adnexal mass, the preoperative assessment was of prime importance to rule out and/or to diagnose malignancy. The elements of the preoperative assessment were the following: clinical examination, ultrasonography, doppler and assays for tumor markers. In the presence of extra-ovarian signs of malignancy during the preoperative workup the patient underwent laparotomy and no initial laparoscopy. When a laparoscopy was carried out, the first phase was purely diagnostic. If any extra-ovarian signs existed which raised the suspicion of malignancy during this diagnostic laparoscopy phase, we resorted to laparotomy. In other situations, it was possible to perform a laparoscopic adnexectomy. When we carried out adnexectomy via laparoscopy, the different steps included the following: diagnostic investigation of the adnexa and then the whole abdomino-pelvic cavity with systematic peritoneal cytology sampling; identification of the ureters; and if necessary, preliminary adhesiolysis; the adnexectomy itself, with hemostasis using bipolar coagulation in every case; extraction of the excised tissues which in certain situations (ovarian cysts in the peri- or post-menopausal period, dermoid cysts, endometriotic cysts, etc.) required the use of an endoscopic bag (13); and checking on hemostasis and thorough abdomino-pelvic cleaning.