{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T20:56:38Z","timestamp":1777323398265,"version":"3.51.4"},"reference-count":23,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T00:00:00Z","timestamp":1777075200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: The management of large benign ovarian cysts in women of reproductive age requires balancing minimally invasive surgery with oncologic safety and preservation of ovarian function. Laparoscopic cystectomy for large cysts is technically challenging and carries an increased risk of intraoperative rupture and spillage; Case Presentation: We describe a novel hybrid laparoscopic\u2013extracorporeal technique in which controlled cyst decompression is performed using a balloon-tipped trocar through a suprapubic port under direct laparoscopic visualization. The ovary is then carefully mobilized and exteriorized through the same incision, allowing extracorporeal cystectomy and ovarian reconstruction before returning the adnexa to the abdominal cavity. This approach was applied in a series of six patients with large benign-appearing ovarian cysts, including one 42-year-old patient with an 18 cm multilocular mature cystic teratoma. There were no intraoperative or postoperative complications, no conversions to laparotomy, and all patients were discharged on postoperative day 1. Follow-up at six weeks and subsequent imaging at nine months demonstrated preserved ovarian architecture, normal menstrual function, and high patient satisfaction; Conclusions: The hybrid laparoscopic\u2013extracorporeal approach appears feasible and may offer a safe surgical option in carefully selected patients, allowing fertility preservation while minimizing the risk of spillage. Further studies are needed to evaluate reproducibility, oncologic safety, and long-term reproductive outcomes.<\/jats:p>","DOI":"10.3390\/reports9020131","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T19:24:51Z","timestamp":1777317891000},"page":"131","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Novel Hybrid Laparoscopic\u2013Extracorporeal Technique for Fertility-Preserving Management of Large Benign Ovarian Cysts: A Case Report"],"prefix":"10.3390","volume":"9","author":[{"given":"Sofia","family":"Makrydima","sequence":"first","affiliation":[{"name":"\u201cElena Venizelou\u201d General Hospital, 11521 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2442-3772","authenticated-orcid":false,"given":"Charalampos","family":"Milionis","sequence":"additional","affiliation":[{"name":"\u201cElena Venizelou\u201d General Hospital, 11521 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1177\/1553350611432722","article-title":"Laparoscopic management of large ovarian cysts","volume":"19","author":"Vlahos","year":"2012","journal-title":"Surg. Innov."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.ygyno.2007.08.085","article-title":"Laparoscopic surgery for large benign ovarian cysts","volume":"108","author":"Eltabbakh","year":"2008","journal-title":"Gynecol. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3883","DOI":"10.1007\/s00464-019-07154-6","article-title":"Short- and long-term outcomes of intraoperative spillage during laparoscopic removal of benign ovarian cysts","volume":"34","author":"Hizkiyahu","year":"2020","journal-title":"Surg. Endosc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"101745","DOI":"10.1016\/j.cpsurg.2025.101745","article-title":"Clinical effectiveness analysis of laparoscopic surgery for benign ovarian tumors: A comparative study of ovarian cystectomy and salpingo-oophorectomy","volume":"66","author":"Du","year":"2025","journal-title":"Curr. Probl. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Wang, X., and Li, Y. (2021). Comparison of perioperative outcomes of single-port laparoscopy, three-port laparoscopy and conventional laparotomy in removing giant ovarian cysts larger than 15 cm. BMC Surg., 21.","DOI":"10.1186\/s12893-021-01205-3"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/00001703-200102000-00002","article-title":"Risk of spread of ovarian cancer after laparoscopic surgery","volume":"13","author":"Canis","year":"2001","journal-title":"Curr. Opin. Obstet. Gynecol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2821","DOI":"10.1007\/s00404-023-07368-z","article-title":"Ovarian cancer management in an ESGO ovarian cancer center of excellence: A systematic case study of the interprofessional and interdisciplinary interaction","volume":"309","author":"Krankenberg","year":"2024","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"215","DOI":"10.4103\/gmit.gmit_122_21","article-title":"Feasibility and safety of laparoscopic surgery in large ovarian masses","volume":"11","author":"Kinay","year":"2022","journal-title":"Gynecol. Minim. Invasive Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1007\/s00404-009-1138-5","article-title":"Posterior colpotomy revisited: A forgotten route for retrieving larger benign ovarian lesions following laparoscopic excision","volume":"281","author":"Pillai","year":"2010","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_10","first-page":"8640871","article-title":"Laparoscopic cystectomy in-a-bag of an intact cyst: Is it feasible and spillage-free after all?","volume":"2016","author":"Detorakis","year":"2016","journal-title":"Minim. Invasive Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"14","DOI":"10.25259\/JCIS_197_2025","article-title":"Post-ovarian cystectomy imaging appearances for borderline ovarian tumors: Pearls and pitfalls","volume":"16","author":"Kuo","year":"2026","journal-title":"J. Clin. Imaging Sci."},{"key":"ref_12","first-page":"17","article-title":"A novel minilaparotomy approach for large ovarian cysts","volume":"16","author":"Pelosi","year":"2004","journal-title":"OBG Manag."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1016\/j.jmig.2022.06.018","article-title":"Protected laparoscopic large ovarian cyst aspiration: A 5-step alternative to laparotomy","volume":"29","author":"Hudry","year":"2022","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_14","first-page":"766","article-title":"A novel surgical technique for the large ovarian cystic mass-combined mini-laparotomy and laparoscopy","volume":"37","author":"Li","year":"2016","journal-title":"Eur. J. Gynaecol. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1097\/AOG.0000000000004455","article-title":"Intraoperative rupture of the ovarian capsule in early-stage ovarian cancer: A meta-analysis","volume":"138","author":"Dioun","year":"2021","journal-title":"Obstet. Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/j.jmig.2020.11.025","article-title":"Short- and long-term complications of intraoperative benign ovarian cyst spillage: A systematic review and meta-analysis","volume":"28","author":"Eisenberg","year":"2021","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1097\/01.AOG.0000275265.99653.64","article-title":"Laparoscopy compared with laparoscopically guided minilaparotomy for large adnexal masses: A randomized controlled trial","volume":"110","author":"Panici","year":"2007","journal-title":"Obstet. Gynecol."},{"key":"ref_18","first-page":"1007","article-title":"Leak-proof puncture of ovarian cysts: Instant mounting of plastic bag using cyanoacrylate adhesive","volume":"97","author":"Shozu","year":"2001","journal-title":"Obstet. Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1007\/s00404-011-2115-3","article-title":"Leak-proof extracorporeal drainage for management of large ovarian tumors","volume":"285","author":"Weng","year":"2012","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1080\/01443615.2020.1718626","article-title":"Leak-proof technique in laparoscopic surgery for large ovarian cysts","volume":"41","author":"Song","year":"2021","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Shaltout, M.F., Maged, A.M., Abdella, R., Sediek, M.M., Dahab, S., Elsherbini, M.M., Elkomy, R.O., and Zaki, S.S. (2022). Laparoscopic guided minilaparotomy: A modified technique for management of benign large ovarian cysts. BMC Women\u2019s Health, 22.","DOI":"10.1186\/s12905-022-01853-4"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1007\/s00464-005-0596-5","article-title":"Minimal access approach to the management of large ovarian cysts","volume":"21","author":"Goh","year":"2007","journal-title":"Surg. Endosc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.jmig.2016.12.010","article-title":"Impact of cystectomy on ovarian reserve: Review of the literature","volume":"24","author":"Alammari","year":"2017","journal-title":"J. Minim. Invasive Gynecol."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/2\/131\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T20:20:46Z","timestamp":1777321246000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/2\/131"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,25]]},"references-count":23,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["reports9020131"],"URL":"https:\/\/doi.org\/10.3390\/reports9020131","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,25]]}}}