Female pelvic cysts are very common gynecological diseases in women, most of which come from ovary. The clinical manifestations appear when the cysts reach enormous dimensions. Giant ovarian cysts (GOCs) are tumors larger than 10 cm in diameters. Due to improved imaging techniques, giant abdominal cyst has become increasingly rare. The patients can present with rare complications such as torsion, intestine obstruction, hydronephrosis in addition to causing non-specific abdominal distension, pain, nausea and vomiting and changes in defecation habits[7–10]. As the nonspecific clinical manifestations of giant ovarian cysts, the differential diagnoses include the giant cysts from other intra-abdominal organs (e.g. gastrointestinal, urological, or lymphatic).
The treatment of ovarian cysts depends on the patient's age, the size of the cyst, and its histopathological feature. Excision of the intact cysts for histology is the gold standard.Most giant ovarian cysts are benign and are treated by surgical excision generally either by cystectomy or salpingo-oophorectomy . It is utmost important to exclude any possibility of malignant tumor before operation.In the past, resection of the cystic mass by exploratory laparotomy is the preferred management strategy. But for laparotomy of benign giant cysts, the huge incision caused trouble to the patients (especially young patients). A study shows that with the development of advanced technology, it is feasible to use laparoscopic surgery to remove giant ovarian cysts on the basis of selecting suitable patients and laparoscopic experts. Recently, laparoscopic-assisted excision of these giant cystic masses has been reported in several literatures[6, 16, 17]. How to avoid the leakage of cyst fluid has become a challenge in laparoscopic surgery for treating giant ovarian cysts.
In recent years, single-port laparoscopic surgery has become a hot spot as it uses the natural pores of the navel to hide the surgical incision and has the characteristics of perfect cosmetic results and fast postoperative recovery. In our study,we used single-port laparoscope to perform surgery on a slightly larger incision at the umbilicus, which exposed the visual field better and avoided the exudation of liquid in the giant cysts. In order to avoid the impact of sudden drop of intraperitoneal pressure on patients, we used the method previously described to slowly reduce the fluid in the giant cyst. Facts had proved that this method is effective, these patients did not appear related discomfort symptoms. We use the wound protector-retractor to protect the incision and reduce the risk of cell spillage. The endopouch specimen retrieval bag was used to take out the specimen after resection of the diseased tissue, which reduced the potential risks of the leakage of cells and residual cystic fluid. These measures ensured the safety of the operation. Although giant ovarian cysts are larger than 10 cm in diameter, we still selected cysts larger than 20 cm in diameter for study, which are more rare in clinic. We analyzed the general information and surgical outcomes of these patients and found that single-port laparoscopic surgery did not increase the adverse prognosis of patients. On the contrary, minimally invasive surgery and perfect cosmetic results accelerated the recovery and satisfaction of patients.
Despite the advantages of single-port laparoscopic surgery, not all giant ovarian cysts are suitable for this type of surgery. We need to evaluate the patient's condition before operation rigorously, and it is very important to exclude any possible malignant tumors before operation. Single-port laparoscopic surgery is difficult to form an operation triangle as its limited operation space, relatively concentrated instruments and mutual interference which places high demands on the surgeon. It is necessary for us to improve the safety of surgery through more research.