Simplified 'in-Bag' Ovarian Dermoid Cystectomy through Single-Site Incision in a 16 Week Pregnant Patient

Study Objective To demonstrate a novel “in-bag” ovarian cystectomy technique for a large adnexal mass in pregnancy. Design Stepwise demonstration with narrated video. Setting An academic tertiary care hospital. Patients or Participants The patient is a 26-year-old G1P0 at 7 weeks and 3 days gestation who presented to the ED with persistent left pelvic pain and diagnosed with a 16 × 10 × 12 cm dermoid cyst. She re-presented at 16 weeks and 3 days gestation with worsening pelvic pain and decision was made to proceed with surgical intervention. Interventions Laparoscopic transumbilical single-site surgery for the surgical management of adnexal masses in pregnancy has been demonstrated to be feasible and safe. However, single-site laparoscopic ovarian cystectomy can be very challenging in pregnancy, especially when the need for suturing arises. Exteriorizing the ovary and cyst after intraperitoneal drainage may allow for extracorporeal suturing that is faster and easier; however, it will increase the probability of spillage of cystic contents if it is not performed in a bag, which can then cause peritonitis in cases of dermoid cysts. A combination of in-bag and extracorporeal ovarian cystectomy is a novel alternative minimally invasive approach that is more cosmetic, safer, and effective. Measurements and Main Results The procedure was successfully performed in approximately 110 minutes, and the fetal heart rate post-procedure was 128bpm via bedside transabdominal ultrasound. Estimated blood loss was 5 mL, and the patient was discharged the same day with an uneventful four-week post-op follow-up. Conclusion Laparoscopic single site “in-bag” ovarian dermoid cystectomy is feasible, effective, and safe in pregnant patients with a large adnexal mass. This technique results in better stabilization of the ovarian cyst and reduction of cystic content spillage.