73 A recent study has confirmed that minimally invasive surgery (MIS) is an effective and safe approach for managing ovarian teratomas, also known as dermoid cysts, which account for 10–25% of all ovarian tumours. The findings, published in the American Journal of Obstetrics and Gynecology, come from an extensive review of over 1,000 cases of ovarian teratoma surgeries conducted at a single institution between 2004 and 2015. Researchers have emphasised that despite the increased risk of cyst spillage during MIS, the feared complication of chemical peritonitis remains extremely rare. A team of medical experts led the study, which examined 1,054 cases of surgically treated ovarian teratomas. Among the cases, 113 (10.7%) were bilateral, and the mean age of patients was 38 years. The size of the cysts ranged from microscopic to over 20 cm, with an average size of 6.26 cm. The research aimed to update the current understanding of ovarian teratomas by assessing the epidemiology, risk factors such as torsion, and complications that may arise from different surgical approaches. A key takeaway from the study is the prevalence of minimally invasive surgical methods used in more than 70% of the cases. These approaches have significantly reduced perioperative complications compared to traditional open surgery, providing reassurance for patients and surgeons alike. However, the rate of cyst spillage was higher in cases treated with laparoscopy compared to laparotomy. Although cyst spillage occurred in nearly 40% of MIS cases, the study reported only one case of chemical peritonitis out of 394 patients with cyst spillage. This finding challenges prior concerns surrounding the dangers of MIS in cyst management. The findings suggest the use of endoscopic bags and rigorous irrigation techniques have contributed to reducing the risk of chemical peritonitis, a rare but serious inflammatory reaction that can occur after cyst contents spill into the abdominal cavity. The overall complication rates were also lower for patients who underwent MIS. These patients experienced shorter hospital stays and a reduced risk of bowel injury and blood loss. On average, patients who had laparoscopic surgery stayed in hospital for 0.2 days, compared to 2.8 days for those who underwent open surgery. The study also explored the management of ovarian teratomas in pregnant women, a cohort that included 100 cases. Findings revealed a preference for laparoscopic surgery during the first trimester of pregnancy, with laparotomy becoming more common as pregnancy progressed into the second and third trimesters. MIS in pregnant patients was associated with a lower rate of postoperative complications. Despite concerns about torsion, a condition in which the ovary twists, cutting off its blood supply, the study found that the overall torsion rate was relatively low, at 5.6%. However, larger cysts were more likely to cause torsion, with rates increasing from 1.9% in cysts smaller than 5 cm to 16.7% for those exceeding 20 cm. The study concluded that minimally invasive surgery is a safe and effective option for managing ovarian teratomas, with relatively low complication rates. It also provides valuable insights for clinicians when counselling patients, particularly those concerned about the risks of MIS and chemical peritonitis. The findings offer a reassuring outlook for women requiring surgical management of dermoid cysts, particularly those who are pregnant, as MIS continues to be the preferred method in modern gynaecology.