Challenging differential diagnosis, Unusual setting of medical care, Rare co-existance of disease or pathology
Greg J. Marchand, Andrea Carpenter, Kelly Ware, Janelle Vallejo, Alexa King, Sienna Anderson, Stacy Ruther, Giovanna Brazil, Kaitlynne Cieminski, Hollie Ulibarri, Nicolas Calteux, Katelyn Sainz
Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
Am J Case Rep 2021; 22:e930659
Available online: 2021-03-09
Advances in minimally invasive surgery are essential for the improvement of patient care, overall health care efficiency, and total cost reductions. Morcellation, the technique used in the present case, is often used to aid minimally invasive laparoscopic procedures, whereby larger tissue specimens are broken down and divided to be removed via smaller incisions. Morcellation has become controversial in the medical community owing to the risk of the procedure spreading an occult malignancy.
CASE REPORT: A 47-year-old woman with obesity presented with right-sided pelvic pain and suspicion of ovarian torsion. The patient experienced severe acute pain and was taken to the operating room for laparoscopy to remove the left-sided adnexal mass seen on imaging. During surgery, there was no evidence of torsion, and the mass was perfused. During removal of the entire tumor, blunt instruments were utilized for in-bag manual morcellation to avoid spillage of the contents of the bag, which were then sent for frozen section analysis, and a diagnosis of adenocarcinoma of the ovary was made. Once the tumor was removed, a board-certified gynecologic oncologist was consulted to assist with the remainder of the procedure. Following this, the ovarian cancer staging procedure was able to be completed laparoscopically.
CONCLUSIONS: This technique of in-bag manual morcellation using blunt instruments allows laparoscopic procedures to be performed on large tissue specimens with potential malignancies without spreading cancerous tissue, overcoming the associated risks of dissemination of malignancy. This technique is therefore more beneficial to patients.
Keywords: Gynecologic Surgical Procedures, Laparoscopy, Ovarian Neoplasms, Surgical Procedures, Minimally Invasive