Laparoscopic removal of adnexal cysts: is it possible to decrease inadvertent intraoperative rupture rate?

Objective: The objective of the study was to characterize surgical risks for intraoperative rupture of benign adnexal lesions during laparoscopy. Study Design: We conducted a retrospective review of cases of laparoscopic removal of ovarian cysts (adnexectomy or cystectomy) in our institution from 2002-2006, excluding procedures in which cysts were intentionally ruptured. Results: There were 256 operations (263 ovarian cysts). The patients' mean age was 40.9 ± 15.8 years. The overall rate of inadvertent intraoperative rupture of cyst was 16.6% (adnexectomies 7.4% and conservative cystectomies 29.5%; P < .001). There was no significant correlation between inadvertent intraoperative rupture and adnexal torsion, pelvic adhesions, bilateral adnexal surgery, concomitant uterine surgery, presence of pelvic endometriotic foci, pregnancy, and surgeons' experience. Only cyst size and cystectomy procedure were positively and significantly associated with inadvertent cyst rupture (multivariate regression analysis). Conclusion: Inadvertent intralaparoscopic rupture of adnexal cyst is significantly associated with cystectomies of large ovarian cysts for which laparotomy or laparoscopic-assisted extracorporeal cystectomy should be considered.