Single-sitting laparoscopy for large pelvic mass and umbilical hernia through the Lee-Huang Portal

Background: Ovarian fibrothecoma is a benign ovarian tumor that is likely to be misdiagnosed as a malignancy, especially if the tumor is accompanied by ascites. Treatment for elderly patients seems challenging, because of the condition and other complications that interfere with good quality of life. Case: An 82-year-old Taiwanese woman with a solid ovarian mass, ascites, elevated CA-125, and an umbilical hernia is presented. This patient was referred for progressive abdominal distention without pain. She had noticed a significant weight loss within the previous year, despite her normal appetite. Her CA-125 level was 125 U/mL. Computed tomography revealed a right-sided solid ovarian mass that appeared to be malignant and that measured 12.4×11.4×6.3 cm. The mass was accompanied by ascites, and a small umbilical herniation. The left ovary was normal. The patient underwent single-sitting laparoscopic-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy and umbilical hernioplasty (Mayo repair technique) using the Lee-Huang portal. Results: The frozen section showed that the mass was a fibrothecoma. No recurrence of the hernia was noted at a 2-year follow-up since the patient was operated on. Conclusions: Laparoscopy is a multifunction procedure, with several advantages and minimal side-effects especially for high-risk patients, and the Lee-Huang portal is very important for laparoscopic approach. (J GYNECOL SURG 29:216)