Nathan Mordel, M.D. »Janet Lefkowitz, D.O. »

Robotically Assisted Laparoscopic Excision of Benign Ovarian Tumors

Medical Background

CM was 24-year-old-woman who experienced worsening pain in her left pelvic area. A pelvic exam from her OB/GYN revealed a tender, grapefruit sized left pelvic mass. Ultrasound confirmed that the mass measured 5 inches (12 centimeters) in diameter, a suspicious size for a left ovarian dermoid tumor. Although the tumor was benign, removing it was still important. Untreated, the tumor could have led to the loss of the ovary or incur rupture and spillage inside the abdomen resulting in peritonitis or torsion (twisting) that would strangle the blood flow and bring on necrosis of the entire ovary.

CM was informed by her OB/GYN that a traditional laparotomy (opening of the abdomen) would require a 5 inch incision at the very least and a 2 day hospital stay followed by a 4-6 week recovery period. Furthermore, her OB/GYN explained that the procedure would put her at significant risk of losing her left ovary altogether. Her busy schedule and long-term desire to start a family made this an unacceptable option. CM sought an alternative at Atlanta Minimally Invasive Gynecological Surgery Center, where she was advised to undergo a Robotically Assisted Laparoscopic Excision of Ovarian Tumor (RALEOT).

Patient Results and Benefits of Minimally Invasive Robotically Assisted Laparoscopic Excision of Ovarian Tumor

CM’s tumor was removed via successful RALEOT surgery that used 4 tiny incisions ranging from ¼ to ½ inches. There was no loss of blood and no spillage of tumor contents into the abdominal cavity. With her left ovary preserved, CM was able to return home the same day and resume her normal activities in 2 weeks.

Proper recognition and understanding of surgical anatomy is paramount to successful and safe completion of any surgery, including RALEOT. Correct tissue handling and “prophylactic” hemostasis are equally important. These principles need to be followed regardless of the ovarian tumor excision route. Employment of Robotic and/or Laparoscopic instrumentation can’t “miraculously” replace or even enhance these principles.

Preoperative imaging consisting of CT scan with contrast (absence of ascites, omental cake, lymphadenopathy) as well as tumor markers within normal limits are important to rule out malignant ovarian mass. Preservation of healthy ovarian tissue while avoiding spillage of tumor contents is imperative. Removal of large ovarian tumor requires large endocatch bag inserted through a 15 millimeter port. Intraoperative frozen section may be needed to confirm the benign nature of the tumor.

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