Abstract
Introduction:
About 1% to 4% of pregnancies are complicated by adnexal masses, most of which are benign cysts and regress in the first trimester. 1,2 When they do not regress surgery may be needed to rule out malignancy or prevent ovarian torsion or rupture. 1 –5 The video presents a patient with a large adnexal cyst that occurred during pregnancy and required operative treatment.
Materials and Methods:
A 25-year-old woman, 5 weeks pregnant, with no prior medical history, presented to the emergency department with pelvic pain. On physical examination, she had a palpable abdominal mass from the pelvis to the inferior hepatic border. On ultrasound and magnetic resonance imaging, a gestational sac was identified compatible with a 5-week pregnancy and an 18 cm right adnexal mass consisting of a unilocular cyst with no septa or papillary projections. The patient was treated nonoperatively at that time and discharged after her symptoms resolved. The patient was evaluated at 18 weeks gestation and the cyst maintained the same dimensions. Owing to the risk of rupture and future obstruction of labor, a multidisciplinary team recommended surgical resection of the mass. An exploratory laparoscopy was performed and confirmed the gravid uterus and large cyst (∼15 cm). Initially, the cyst was drained. Subsequently, the cyst capsule was dissected from the viable ovary. Owing to the dimensions of the cyst, the ovary and cystic capsule were exteriorized through the right lower abdominal wall port. The capsule of the cyst was then removed from the ovary. Finally, the right adnexa was reintroduced into the abdominal cavity.
Results:
The laparoscopic cystectomy operative time was 60 minutes. No surgical or postoperative complications occurred and the patient was discharged from the hospital on postoperative day three. Pathology revealed a mucinous cystadenoma with no signs of malignancy. The pregnancy developed normally to term and delivery by caesarean section occurred at 40 weeks gestation because of arrested labor. The newborn girl was 3430 g with an Apgar score of 9/10/10, and no neonatal complications were described.
Conclusions:
Multiple studies demonstrate that a laparoscopic approach during pregnancy is beneficial because of less uterine manipulation, shorter operative time, decreased length of hospital stay, and less postoperative pain. As noted in this video, laparoscopy during pregnancy is a viable option to treat adnexal pathology.
The authors whose names are listed certify that they have no affiliations with or involvement in any organization or entity with any financial or nonfinancial interest in the subject matter or materials discussed in this video article.
Runtime of video: 7 mins 20 secs
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