Balancing Complete Excision and Maximal Ovarian Conservation: Laparoscopic Ovarian Cystectomy Assisted by an Articulating Linear Stapler - A Case Report.

Ovarian cysts are common benign gynecologic tumors in women of reproductive age. Laparoscopic ovarian cystectomy (LOC) is generally preferred when fertility preservation is intended. Large cysts, or those with intraoperative frozen-section findings suspicious for borderline lesions, present a technical dilemma: the cyst wall must be excised completely while normal ovarian cortex is conserved, electrothermal injury is limited, and spillage of cyst contents is avoided. Hemostasis, operative duration, and postoperative ovarian reserve are all relevant to long-term reproductive outcomes. We describe a 43-year-old Chinese woman with ovarian cysts who presented with abdominal pain worsened by physical activity. She underwent laparoscopic bilateral ovarian cystectomy using an articulating endoscopic linear stapler (also called an articulating endoscopic linear cutter). The stapler was applied for cyst-wall division and mechanical hemostasis. The operation was completed in 95 minutes, with an estimated blood loss of approximately 50 mL. The postoperative course was uneventful. This single case demonstrates the technical feasibility of stapler-assisted laparoscopic bilateral ovarian cystectomy. Because only one patient was treated, no conclusion can be drawn regarding preservation of ovarian reserve, improved safety, or superiority over conventional cystectomy. Comparative studies are needed to define its role.