Laparoscopic Surgery For Ovarian Dermoid Cyst

Aaradhya Sharma

https://www.laparoscopyhospital.com/SERV01.HTM  This video demonstrates Laparoscopic Surgery For Ovarian Dermoid Cyst performed by Dr. R K Mishra at World Laparoscopy Hospital. Laparoscopy is the standard treatment of ovarian dermoid cysts and provides many advantages over laparotomy. However, the laparoscopic approach could result in chemical peritonitis caused by the spilled contents of a ruptured dermoid cyst. Good quality endo bag should be used to prevent spillage.   For more information please contact:  World Laparoscopy Hospital  Cyber City, Gurugram, NCR DELHI  INDIA 122002  Phone & WhatsApp: +919811416838, + 91 9999677788

Transcript

00:00hello friends this is a case of laparoscopic dermoid cystectomy ovary and cysts are of many

00:09type today we will see how to perform ovary and dermoid surgery without a spillage spillage is

00:16very important to control and for that we will use endobag if you use proper endobag you can

00:23prevent the spillage of the dermoid ovary and cyst surgery here we have started the surgery

00:30and this patient has four centimeter dermoid cyst on the left side and we will introduce the varus

00:38needle in the inferior crease of the umbilicus and the three click sound will come and then irrigation

00:46suction and hanging drop test will be performed just to make it sure that varus needle has entered

00:52into the abdominal cavity nicely and then pneumo petronium is started here we will use the

00:5815 millimeter of mercury preset pressure and approximately 1.5 liter gas has been used to

01:05create the pneumo petronium after that we will enlarge the same incision to 11 mm and then we will

01:13introduce the 11 mm primary trocar that is optical trocar here we are just dilating little bit the

01:20inferior crease of umbilicus and this 11 mm trocar has been introduced after that we will connect the

01:28tubing and we will increase the preset pressure and then telescope has been introduced we can see here

01:34that after introducing telescope this is a sigmaoid colon here the uterus this is the dermoid cyst on the left

01:43side here the first we will use one endobag and that endobag will be introduced with the contralateral port

01:51port that is a self-retaining disposable endobag that is made of high quality polypropylene and that is

02:00useful for the dermoid ovary and cystectomy now you can drop the cyst and ovary into the endobag so that

02:09if any spillage happen it will control it now we can see here this side sigmaoid colon is little more stuck

02:17to the left side of the triangle of doom so we will do little bit mobilization of the sigmaoid colon

02:25that may be required because here we can see it is it is disturbing and it's coming in the way and maybe

02:31the energy can touch the sigmaoid colon so it was little bit mobilized and after that we are doing the

02:40ovarian cystectomy this ovarian cystectomy is very easy and with the harmonic you can open the

02:46outer ovarian cortex and with one Maryland and one atraumatic rasper you can just separate it easily

02:54care should be taken that directly holding the cyst with the Maryland should be avoided and by opening

03:02the jaw you should do dissect all around equally and it should be gentle another important point is

03:09that when you separate it you should try not to hold the fimbria of the tube that may create a

03:16structure and care should be taken that it should not puncture if you will remain gentle and pushing

03:23and pulling technique it won't get punctured and try to keep the convexity of the Maryland towards the

03:29cyst so that you can use one grasper also here we have removed the Maryland and this is the atraumatic

03:36grasper now because being pointed Maryland sometime can rupture the cyst and this is having a very good

03:43plane and you can hold with the left hand the ovarian cortex and with the light right hand you can slowly

03:49separate the cyst inside the endobag

03:59gentle traction on the left side and then slowly the cyst is coming out you should try to do it all

04:06around equally going one side more and another side less is not a good idea it should slowly stripped

04:14at this point there is a more chances of spillage so you should be gentle

04:18an atraumatic grasper is very important to separate it without puncturing again we will encircle it and

04:26try to remain all around equal some people they use hydro dissection at this point but mostly in the

04:32hydro dissection cysts get ruptured and we will try it that it should come out without puncturing so it's

04:39almost over now just 25 percent of the part of the cyst is only attached and slowly it can be punctured

04:49so it is now almost out and there is no any blood loss there is no any bleeding because once you have

05:04a good pain here the fimbria is there so you should try to remain away from the fimbria this is the ovarian

05:10cortex and then slowly it is the last part is separated

05:31once it is separated then you can do little suction irrigation just to wash the inside of the cystic

05:38area to make it sure and to visualize that there should not be any bleeding so absolutely no bleeding

05:44is found and if the bladder is there with the bipolar you can just try to desiccate the small points

05:52and bleeding can be stopped there is no need of suturing just you should invert it just put all the

05:59content inside the cyst and you should invert the outer wall of the ovarian cortex and drop in the ovarian

06:05fossa after that we will puncture the cyst inside the endobag because sometime when you try to puncture

06:14it from outside with the ovum forcep it may get slipped so with the harmonic we are carefully puncturing

06:21it so that any part should not be spilled out if you puncture it right now taking it out will be very

06:28easy and once the mouth of the endobag will come out with the ovum forcep you can drag the cystic content

06:35and here the fatty content of the dermoid is coming out there are few hair balls inside the dermoid

06:41which we will take it out with the ovum forcep so now it's punctured and after that we will here

06:49outside we can see with the ovum forcep the cyst is pulled and when you are using endobag this port

06:55should must be closed otherwise there is a chance of hernia so thank you very much

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