Design: Case report

Setting: Large academic center

Patients or Participants: 32yo G0 with history of laparoscopic confirmed endometriosis who presented with a 17cm right ovarian mass. After risks, benefits and alternatives were discussed she was consented for a laparoscopic assisted extracorporeal ovarian cystectomy with possible excision of endometriosis.

Interventions:

Key surgical steps are illustrated including:

1. Diagnostic laparoscopy with entry at Palmers point
2. Mini-laparotomy with placement of a small self-retaining retractor at the umbilicus
3. Application of an adhesive barrier
4. Cyst aspiration initially with a needle followed by blunt suction tip for deep drainage.
5. Gentle extraction of the ovary and cyst
6. Extracorporeal cystectomy
7. Suture closure of ovarian cortex.
8. Application of a gel point for subsequent diagnostic or operative laparoscopy

Measurements and Main Results: Patient discharged home on POD0 and had an uncomplicated postoperative course. Pathology returned consistent with a benign dermoid cyst.

Conclusion: Laparoscopic assisted extracorporeal ovarian cystectomy is a feasible and effective option for large ovarian cysts allowing for the benefits of minimally invasive surgery while reducing risks of intraperitoneal spillage.