Objective
We sought to investigate the reproductive outcomes of women who underwent laparoscopic removal of benign cystic teratoma with or without intraoperative spillage.
Study Design
The reproductive outcomes of reproductive age women following laparoscopic removal of benign cystic teratoma from 1997 through 2007 were investigated by a telephone questionnaire.
Results
In all, 128 reproductive age women underwent benign cystic teratoma removal, and reproductive outcomes were available for 45. Among those 45 women, intraoperative spillage occurred in 16 (35.6%). The rate of spontaneous pregnancies was significantly lower for the nonspillage compared to the intraoperative spillage groups (20/29 [68.9%] vs 16/16 [100%], respectively; P = .01). However, the median time from surgery to the first pregnancy was similar (22 and 18.5 months, respectively; P = .9). From the 9 remaining women in the nonspillage group, 4 conceived with ovulation induction, 2 conceived with in vitro fertilization, and 3 were infertile.
Conclusion
Intraoperative spillage of benign cystic teratomas does not lead to long-term infertility.
Benign mature teratomas (dermoid cysts) contain tissue derived from all 3 germ cell layers with a predominance of ectodermal components. These are the most common germ cell tumors, and account for up to 44-70% of benign ovarian neoplasms in young women. Benign mature teratomas are usually asymptomatic, but since they may cause complications, such as torsion and rupture, it is usually recommended that they be removed. A number of studies have shown the feasibility of laparoscopic removal of benign mature teratomas. The advantages of a laparoscopic approach compared to laparotomy were shorter hospital stay, reduced postoperative pain, and better cosmetic results. One possible disadvantage of laparoscopy, however, is the higher risk for intraoperative cyst rupture (especially during cystectomy procedures), with spillage of the cyst’s contents. The consequences of benign mature teratoma spillage may be an aseptic inflammatory peritoneal reaction (chemical peritonitis) that may result from the exposure of the peritoneum to material such as hair and viscous secretions, although this complication appears to be rare. It has also been suggested that peritoneal adhesions may be a long-term consequence of chemical peritonitis, causing mechanical infertility.
The pregnancy rate following removal of benign mature teratomas has been reported in only 2 small series. In the current study, we evaluated the fertility of a larger cohort of women who underwent laparoscopic surgery for the removal of benign mature teratomas in order to determine whether spillage of benign mature teratomas causes long-term infertility.
Materials and Methods
We conducted a computerized retrospective search for cases of women who underwent laparoscopic removal of benign mature teratomas by either adnexectomy or cystectomy from 1997 through 2007 at our institution. Data on the patients’ demographics, operative findings, surgical procedure, and pathologic diagnoses were retrospectively retrieved from their medical records.
All patients had undergone conventional laparoscopy using pneumoperitoneum, and first trocar placement in the umbilicus was the first choice of entry in most cases. Palmer point or a supraumbilical position was chosen for patients with previous laparotomies or in cases where large adnexal cysts were anticipated based on physical examination and preoperative ultrasound scans. Two additional 5- or 10-mm trocars were inserted in the lower abdomen. All specimens were removed by use of retrieval bags and sent for pathologic evaluation and diagnosis. Each occurrence of intraoperative spillage was noted in the operative report, and it was described as being followed by copious lavage of the peritoneal cavity.
The fertility status of the women who were <40 years at time of surgery and who had not undergone tubal sterilization or bilateral salpingo-oophorectomy was assessed by a review of medical records and by telephone interviews. After obtaining the woman’s verbal consent to participate in this study, details regarding fertility, infertility treatment (including ovulation induction and in vitro fertilization), and infertility workup were acquired telephonically. Specifically, diagnosis of “unexplained” infertility required a hysterosalpingogram showing patent fallopian tubes.
Approval to conduct this study was obtained from the institutional review board.
Statistical analysis was performed using the Student t test, the χ 2 test, Fisher’s exact test, and the Mantel-Haenszel test. Significance was set at P < .05.
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