Laparoscopic Management of Suspicious Adnexal Masses

After our initial experience with 757 patients, we have extended our indications for laparoscopy to suspicious adnexal masses. Twenty of 29 ovarian cancers surgically treated since December 1991 were first evaluated by laparoscopy. In all, 321 patients were evaluated by laparoscopy in 1992 and 1993, including 145 women with an ultrasonographically suspicious mass (45.7%). At laparoscopy, 52 masses were diagnosed as suspicious, including 20 cases of malignant ovarian tumors. Sixteen patients were treated by laparotomy (5%), including 11 women with cancer, 2 with teratomas diagnosed as suspicious, and 3 with benign masses that could not be treated endoscopically (0.9%). In cancer treated by laparotomy, staging, including the assessment of the upper abdomen, was begun laparoscopically. When a cancer was managed laparoscopically, an early second look laparoscopy was performed routinely. Since many laparotomies may be avoided, laparoscopic surgery is promising in the management of suspicious adnexal masses. However, from two cases of tumor dissemination, we conclude that this management should follow strict guidelines and needs to be further evaluated.