Introduction: The optimal surgical route for large or potentially malignant ovarian mature cystic teratomas (MCTs) remains debated. Case presentation: We retrospectively included 139 consecutive patients with pathologically confirmed MCT managed laparoscopically at a tertiary center (June 2013–August 2024). Mean cyst size was 9 cm (range 4–20); adnexal torsion occurred in 6%. All procedures were completed minimally invasively; cystectomy and adnexectomy were performed in 40% and 60%, respectively. Intraoperative spillage was 2.2%, with no intra- or postoperative complications. One illustrative case is described: the laparoscopic removal of a giant 8.5-kg MCT and its management. Discussion: With strict containment (controlled decompression, systematic endobagging, sealed extraction) and appropriate expertise, laparoscopy is feasible and oncologically prudent even for giant MCTs and in scenarios at risk of malignant degeneration. Conclusion: In a high-expertise setting using strict no-rupture retrieval protocols, laparoscopy was feasible for MCTs across a broad size range. These results apply to benign-appearing lesions in our single-center series; the accompanying giant cyst is presented as an illustrative case and is not included in pooled outcomes.
Macciò et al. (Fri,) studied this question.