New ultrasound-guided culdotomy of vaginal ovarian cystectomy for pregnant women incarcerated ovarian dermoid cysts in recto-uterine pouch: case reports

Objective of the study: For pregnant women with ovarian cysts, it's important that pregnant uterus is gently treated in laparoscopic cystectomy. Especially the cases incarcerated in recto-uterine pouch are difficult to do laparoscopic ovarian cystectomy. Such cases are suitable for vaginal ovarian cystectomy, but it has severe complication, rectal injury. As a reliable method of transvaginal access, we introduce a new culdotomy procedure and repoted two pregnant cases.

Methods and procedures: New culdotomy procedure uses a technique for the creation of space in the cul-de-sac, transvaginal ultrasound, and a newly developed umbrella Hakko needle. The umbrella Hakko needle consists of a 19-gauge, 30-cm long, metal needle with an overcoat.

Results: In both cases, culdotomy was performed successfully. There were no severe operative complications, rectal injury. Also, there were no blood transfusion, no severe hemoglobin drop, and no postoperative complications.Pregnancy course of both case were no problem, normal vaginal delivery.

Conclusions based on the results: Ultrasound-guided culdotomy of vaginal ovarian cystectomy for pregnant women incarcerated ovarian dermoid cysts in retro-uterine pouch is useful, minimally invasive surgery. It has potential applicability in transvaginal NOTES for pregnant women.