Ovarian Tumor Removal Dermoid Cyst - Teratoma

The dermoid cyst, also known as mature cystic teratoma, is an ovarian tumor of ectodermal, mesodermal, and endodermal origin. They characteristically contain mature tissue and organ components such as skin, hair, teeth, sebaceous glands, cartilage, and thyroid tissue. They are filled with thick, sticky, foul-smelling mucinous debris. The theory of development of a dermoid cyst is failure of a germ cell to undergo Meiosis II. Dermoid cysts represent approximately fifteen percent of all ovarian tumors, and are almost always benign. They are the most common ovarian tumor in women in the second and third decades of life. Most women with these cysts are asymptomatic initially, and symptoms often manifest when the cysts become large enough to cause significant pelvic pain or discomfort. Dermoid cysts have a classic appearance on ultrasound, showing a complex mass with echogenic components. However, definitive diagnosis can only be made by surgical excision. This video demonstrates the process of removal of a large dermoid cyst. Some may be removed laparoscopically. In this case, with a diameter of eighteen centimeters, this cyst requires an abdominal incision. The first steps are to isolate the cyst from the surrounding peritoneum and collect peritoneal washings to rule out the minute chance of a malignancy. The next step is to decompress and drain the mucinous contents to ease the removal. It is important to identifiy the surrounding structures such as the ovaries, fallopian tubes, uterus, the blood supplies, and the ureters. A very important structure is the infundibulo-pelvic (IP) ligament because it contains the ovarian artery and vein. Clamping and ligating the IP ligament is the next step. The final step is to seperate the cyst from the uterus by ligating the uterine ligament. It is crucial to cut open the dermoid cyst to inspect the contents, and send to pathology to further rule out any chance of malignancy.