Single port gasless laparoscopy-assisted mini-laparotomic ovarian resection (SP-GLAMOR): Reasonable treatment for large cystic ovarian tumors with suspicion of malignancy

• SP-GLAMOR overcomes the limitations of laparoscopic surgery for large ovarian cysts.
• SP-GLAMOR improves post-operative quality of life of the patients including cosmesis.

ObjectivesRecent improvements to both optical and laparoscopic instruments have enabled the use of laparoscopic surgery for gynecological procedures as opposed to open abdominal surgery. However, laparoscopic surgery has several potential limitations, including tumor rupture, spillage, incomplete resection of lesions, and trocar insertion site metastasis in surgeries involving large ovarian masses with suspicion of malignancy.Here, we report a case series of large ovarian cystic tumors that were successfully removed by single port gasless laparoscopy assisted mini-laparotomic ovarian resection (SP-GLAMOR), the limitations of which were successfully addressed.MethodsWe reviewed the medical records of 31 women who visited St. Vincent Hospital from April 2006 until April 2011 and were diagnosed with a large cystic ovarian mass with suspicion of malignancy based on imaging studies and tumor markers. After diagnosis, all of the women underwent SP-GLAMOR.ResultsThe median maximal diameter of cysts, median incision size, median surgical duration and median volume of blood loss were 20 cm (range 10.7–45 cm), 3 cm (range 2.5–4 cm), 100 min (range 45–270 min) and 100 mL (range 30–500 mL), respectively. Four cases were diagnosed as malignant disease on frozen sections obtained during the operation, and were converted to open abdominal surgery. No major complications were observed. The four patients diagnosed with malignant disease also underwent adjuvant chemotherapy. All patients were followed up to the time of this report.ConclusionsThe results of our study suggest that the SP-GLAMOR procedure is feasible, with potentially decreased perioperative morbidity and blood loss, faster recovery and better cosmetic results.