Anatomical and surgical considerations for minimally invasive surgery of adnexal mass lesions

During the past decade, minimally invasive surgery has become apart of almost every surgical field. The gynecologic surgeons wereamong the first to recognize the potentials of laparoscopic approachfor management of various benign gynecologic problems. Thelaparoscopic approach offers several advantages over laparotomy.Pelvic and abdominal anatomy appears magnified, allowing precisediagnosis and treatment of the disease adjacent to vital organs, blood vessels, and nerve structures. Additional benefits of laparoscopic approach include minimized bleeding from small vessels afforded by pneumoperitoneum, the elimination of large abdominal incision, less adhesion formation, early ambulation and faster recovery, shorter hospital stay, and less cost to the patient and hospital. Although clinical examination and the results of preoperative work-up often indicate the benign or malignant nature of the adnexal mass, only histology can provide the absolute diagnosis. When malignancy is detected, immediate surgical staging by laparoscopy or by laparotomy is indicated. Operative laparoscopy for evaluation and management of adnexal masses, when performed by a surgeon trained in advanced laparoscopic techniques, is safe and effective and associated with less morbidity compared with open techniques.