Hydrodissection in Bartholin Cyst Excision
For Bartholin cyst excision, hydrodissection is performed using normal saline (0.9% sodium chloride) mixed with lidocaine and epinephrine (typically 1:100,000), injected under pressure into the tissue planes surrounding the cyst to facilitate dissection and reduce bleeding. 1, 2
Hydrodissection Technique and Solution Composition
The hydrodissection solution consists of:
- Saline with lidocaine and epinephrine (1:100,000) injected under pressure into the dissection plane surrounding the Bartholin cyst 2
- 0.9% sodium chloride (normal saline) serves as the primary hydrodissection fluid, similar to techniques used in other thermal ablation procedures 3
- The addition of lidocaine provides local anesthesia while the epinephrine causes vasoconstriction to minimize bleeding during dissection 2
Mechanism and Benefits
Hydrodissection works by:
- Creating a fluid plane between tissue layers that facilitates blunt dissection and complete cyst removal without rupture 1, 2
- Reducing bleeding through both mechanical tamponade and epinephrine-induced vasoconstriction 2
- Minimizing neural and soft-tissue damage by clearly delineating tissue planes 2
- Lowering recurrence rates by enabling complete excision of the cyst wall intact 2
Local Anesthesia Considerations
When performing the procedure:
- Infiltrate anesthetic peripherally around the cyst, not directly into it, as infected or cystic tissue has altered pH that reduces anesthetic efficacy 4
- Use lidocaine with epinephrine at maximum doses of 7 mg/kg or 4.5 mg/kg without epinephrine for adults 3, 4
- 0.25% bupivacaine (maximum 2 mg/kg) can be used for extended anesthesia duration 4
- Liberal volumes may be necessary given the reduced efficacy in abnormal tissue 4
Critical Technical Points
- Make the incision as close to the lesion as possible to optimize cosmetic results and avoid unnecessary tunneling 4
- Use curvilinear incisions following Langer's lines for optimal cosmesis 4
- Meticulous hemostasis is essential as hematoma formation complicates postoperative evaluation and may necessitate unnecessary future interventions 4
Alternative Management Context
While hydrodissection facilitates complete surgical excision, it's worth noting that:
- Bartholin cysts larger than 2 cm typically require drainage as they rarely resolve spontaneously 5
- Surgical excision is definitive but more invasive than other options like Word catheter placement or marsupialization 6, 5
- Hydrodissection represents a modern refinement of traditional excision techniques, making the procedure less bloody and more precise 1