Investigation of the Usefulness of Hanger and Retention Bag and Double Suture Hanger Technique in Preventing Tumor Spillage During Gynecologic Laparoscopic Surgery for Mature Cystic Teratoma

Since the laparoscopic surgical technique and quality for ovarian cystectomy largely depend on the primary surgeon, we investigated the usefulness and feasibility of the hanger and retention bag (HRB) and double suture hanger technique (DSHT) as surgical maneuvers to prevent ovarian tumor spillage, minimizing reliance on the surgeon's skill to the greatest extent possible. HRB and DSHT present several advantages. First, requiring only a retrieval bag and suture, HRB and DSHT are feasible, simple, and cost-effective, and can be performed at any facility with endoscopic surgical equipment. Additionally, the learning curve is extremely short. Second, the port from which the thread is pulled can be positioned anywhere, allowing for parallel, diamond, or other anomalous port configurations. Third, these techniques reduce the risk of tumor spillage during cystectomy. The cyst can be lifted upward toward the abdominal wall while being stored in the HRB, ensuring that even if the contents collapse, they are reliably trapped in the HRB by gravity. Even if the cyst is not fully retracted, fine adjustments can be made as needed using flexible traction. Fourth, while the absence of adhesions around the ovarian cyst is a prerequisite, this approach can also be applied to conditions other than mature cystic teratoma. Furthermore, the HRB and DSHT described here can be used in combination with other surgical devices, depending on the surgeon's skill. This suggests that they may contribute to the advancement of minimally invasive surgery and the prevention of complications. We will report the results of this study, along with the accumulation of cases, in the future.