Prelaparoscopic assessment of ovarian cysts in reproductive-age women (Review)

Ovarian cysts are a common cause of hospital admission in several countries. For this reason, and because of the increasing impact of minimal access surgery in clinical practice, a preoperative assessment that offers a reasonable degree of accuracy is necessary. While transabdominal ultrasonography has not been useful because of relatively poor resolution, the transvaginal probe increases the accuracy of ultrasonography, reducing the risk of unexpected malignancy at laparoscopy. This risk can be further reduced by thorough inspection at laparoscopy characterized by high sensitivity, and by selecting a population with a low risk of ovarian malignancy, such as women of reproductive age. Within this population, it is important to distinguish the different kinds of benign ovarian cysts. A principal ultrasonographic criterion among women of reproductive age is the persistence of the mass. Consideration of the latter feature should reduce the number of unnecessary operative laparoscopies, also reducing the number of wrong differential diagnoses. The above-mentioned approach, associated with the use of simple ultrasonographic findings, seems to have given good reproducibility and accuracy in the differential diagnosis of 'clear' cysts, dermolids and endometriomas in premenopausal women. This approach should permit the preparation of suitable laparoscopic instrumentation and enable the surgeon to decide on the siting of ancillary ports, with the aim of reducing the number of unintended laparotomies and avoiding the risk of complications such as spillage in the case of unrecognized teratomas.