Effectiveness of Prophylactic Laparoscopic Surgery for Benign Adnexal Mass during Pregnancy: A Single-center Retrospective Study

Abstract

Objectives: This study aimed to evaluate the effectiveness of prophylactic laparoscopic surgery for avoiding adnexal torsion in pregnant women with benign adnexal masses.

Materials and methods: This report contains two analyses, each for a different group of patients. Analysis 1: Surgical and pregnancy outcomes were examined among the 126 cases who underwent laparoscopic assisted cystectomy for adnexal masses during pregnancy in our hospital between January 2001 and December 2020. Analysis 2: The incidence of adnexal torsion during pregnancy was evaluated among the cases with adnexal masses ≥5 cm who opted for conservative follow-up in our hospital between January 2011 and December 2020.

Results: In analysis 1, the most common pathological diagnosis was a mature cystic teratoma (76.2%). The mean gestational age at surgery was 13.1 ± 1.3 weeks. No cases were converted to laparotomy and oophorectomy. Regarding delivery outcomes, 97.4% of cases went on to have full-term deliveries. In Analysis 2, the incidence of adnexal mass ≥5 cm that did not resolve spontaneously during pregnancy was 89 cases (0.8%). The frequency of malignancy was 3 cases (0.03%). In 28 cases who opted for conservative treatment, 5 (17.9%) underwent emergency surgery for adnexal torsion.

Conclusion: Prophylactic surgery for benign adnexal masses during pregnancy can be performed laparoscopically and preserved ovarian functions. In pregnant women with adnexal masses that do not resolve spontaneously, planning laparoscopic surgery is considered beneficial for complications, such as adnexal torsion.

Keywords: Adnexal mass during pregnancy; adnexal torsion; laparoscopic-assisted surgery.

Figure 1

Flow chart of Analysis 2 of women who delivered at our hospital from 2011 to 2020

Figure 2

Surgical technique of pneumoperitoneum laparoscopic surgery for benign adnexal masses during pregnancy. (a and b) Surgical incisions were made at the umbilicus, left lower quadrant, and above the pubic bone, (c and d) A SAND balloon catheter^® (Hakko Medical) was inserted to drain fluid from the ovarian mass, (e) Cystectomy and sutures were performed outside the body cavity, (f) After the ovary was returned to the pelvic cavity, the pelvis was irrigated with warm saline to confirm the cessation of bleeding