Laparoscopic removal of an adnexal mass refers to the removal of either benign or malignant tissue from the uterus, ovaries, fallopian tubes, or any of the surrounding tissues using a laparoscope. A surgeon will make minimally invasive incisions (as opposed to an open abdominal incision) and guide a small camera through the incision. The feed is then streamed to a screen.
Adnexal masses can be caused by ectopic pregnancy, tumors (both malignant and benign), as well as polycystic ovary syndrome. In postmenopausal women, masses are more likely to be fibroid tumors, fibromas, or malignant tumors. Most are benign and asymptomatic, and generally require close monitoring rather than surgical treatment. However, if there is suspected malignancy or symptoms associated with adnexal masses, surgical treatment is appropriate.
Who is a candidate?
Candidates who have adnexal masses fit for laparoscopic removal include women whose masses are obviously benign, as well as women with certain early-stage ovarian cancers who wish to maintain fertility.
Who is not a candidate?
Patients whose masses may be malignant may want to consider more invasive procedures in order to fully treat their cancerous growths and prevent tumor recurrence.
A preoperative assessment discussing treatment, anesthesia, and hospital stay should be scheduled in order to prepare mentally for the procedure. Any blood thinners such as aspirin and other pain relievers should be discontinued 7 days before the procedure to reduce the risk of bleeding. If you can, quit smoking, as this will also reduce your risk of excessive bleeding.
You will typically take one or more enemas the night before and the morning of the procedure. Your doctor will likely have you stop eating and drinking the night before surgery.
Laparoscopic removal of an adnexal mass typically requires only an overnight stay in the hospital, during which your doctor will likely insert a urinary catheter. You may experience nausea and shoulder pain, which is caused by bubbles of carbon dioxide gas becoming trapped against your diaphragm. That and other pain can typically be relieved by over-the-counter pain or prescription medication. Light spotting and bleeding can occur in the first few days after the procedure and is normal. Avoid strenuous exercise or intercourse for 4 to 6 weeks, but light exercise is encouraged in order to avoid blood clots and build stamina. Fatigue is common in the first few days after surgery but will subside with time. Patients can return to work 1 to 7 days after the procedure, but should refrain from strenuous activity.
Although laparoscopic removal of an adnexal mass is a relatively low-risk and minimally invasive procedure, risks include excessive bleeding, formation of scar tissue, future pregnancy complications (requiring C-section), or possible necessity of hysterectomy. As with any surgery performed under general anesthesia, there are risks of anesthesia-related complications or allergic reactions to surgical medications. For suspected malignancy cases, removal of an adnexal mass may only be for diagnostic purposes and may be part of a larger, riskier course of cancer treatment.
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