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hi this is dr. Vitali presenting a an
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example of a treatment of a simple
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ovarian dermoid cyst as you are aware
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dermoid cyst are quite common and they
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can be symptomatic or asymptomatic they
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have a tendency to be bilateral in this
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patients case this was a real because
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she had a dermal on the opposite side
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and and the surgeon had not noticed and
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it was a while ago so he might have been
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very small that there was a cyst on the
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contralateral – on the opposite ovary
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the only case their modes are well known
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they’re also called mature cystic
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teratomas because they they derive
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embryologically from a skin element so
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you can find inside these cysts hair or
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teeth and they’re quite scary for the
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inexperienced person to look at for
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regular people because they it’s kind of
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disturbing to think that you have a cyst
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with actual human hair inside your your
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ovaries inside your body most of them
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are behind a great majority of them and
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they should be removed if they are
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leaking if they create problems
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sometimes they can cock they can easily
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cause a twisting of the ovary like in
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this case where the dermoid which is a
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little bit heavy is on one extreme of
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the ovary in allowing it to twist and
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cause pain and strangulate the ovary the
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cysts can be removed very easily well
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this is a small one in most cases easily
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the key is not to allow for any leakage
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because the tissue from the dermoid can
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be very irritating to the valley’s in
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cause car tissue and so it should be
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peeled off very gently without damaging
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the ovaries and i do this procedure
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routinely this is a small one but it
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gives an idea of what we do and I like
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to use two graspers here with a rope
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with a DaVinci robot and just like
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gently nudge it off minimal bleeding or
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almost no bleeding at all and I do not
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repair suture the defect is being shown
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that stitches create more adhesions and
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the key is just to leave here there was
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a little bit
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of a breach because the and you could
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see I slowed it down here some of that
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fatty skin material coming out and you
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can see the human hair also popping out
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a little bit so we of course immediately
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use the suction and make sure that
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there’s no leakage at all very important
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and yes you know the hair is a little
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bit gross for people to look at and a
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little bit disturbing if you’re the
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patient having this because it makes you
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think what is this but it’s common and
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it’s it’s not bad
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you can see the hair there so as I was
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saying you know the keys not to allow
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anything to leak ideally one would want
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not to rupture the cyst at all but
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sometimes it does happen that you have a
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small breach because it’s it can get
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sticky on the ovary so you’ll get a
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little bit of a leak nothing unusual in
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any case these cysts are like i said in
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most cases benign and very commonly
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they’re bilateral so it’s easy to miss
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if the doctor is not aware of this who
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missed the ovary on the contralateral
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the cyst on the contralateral ovary and
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and that can result in a second
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operation which could have been avoided
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in any case you can see that the cyst
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peels off quite well at the base usually
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it’s a little bit stickier a little bit
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more vascular I try to use almost no no
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coagulation on the ovary just a tiny bit
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there on the pedicle and that’s pretty
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much it so that the ovary keeps its
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ovarian reserve and he’s not damaged and
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it doesn’t damage future fertility is
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minimal minimal bleeding almost no
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bleeding and just maybe one tiny leader
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that I have to touch and that’s pretty
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much it that’s it so no excessive
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coagulation nothing major healthy ovary
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just drop back into the pelvis and you
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will heal beautifully again if you have
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either endometriosis or pelvic pain or
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any other problems reach out to me
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dr. Vitali endometriosis is real